Individual
MATTHEW JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
425 WABASHA ST N, SAINT PAUL, MN 55102-1108
(651) 224-6030
Mailing address
425 WABASHA ST N, SAINT PAUL, MN 55102-1108
(651) 224-6030
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
1146620
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1146620
PHARMACY LICENSE
MN
Enumeration date
08/31/2011
Last updated
08/31/2011
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