Provider Demographics
NPI:1720683915
Name:WESTMAN, JACOB ROBERT (PHARMD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:ROBERT
Last Name:WESTMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CENTRAL AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-4594
Mailing Address - Country:US
Mailing Address - Phone:763-497-3568
Mailing Address - Fax:763-497-3605
Practice Address - Street 1:900 CENTRAL AVE E
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-4594
Practice Address - Country:US
Practice Address - Phone:763-497-3568
Practice Address - Fax:763-497-3605
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist