Provider Demographics
NPI:1992219760
Name:DUNLAP, JACOB ZANE (PHARMD,RPH)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ZANE
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 S JAMESTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-3839
Mailing Address - Country:US
Mailing Address - Phone:806-576-9982
Mailing Address - Fax:
Practice Address - Street 1:12902 E 96TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4778
Practice Address - Country:US
Practice Address - Phone:918-272-2376
Practice Address - Fax:918-272-3335
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56692183500000X
OK16916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK16916OtherBOARD OF PHARMACY
TX56692OtherBOARD OF PHARMACY