Individual
RENITA D JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 SAM WALTON DR, RUSSELLVILLE, KY 42276-9311
(270) 726-2966
Mailing address
8764 PALMYRA RD, HOPKINSVILLE, KY 42240-9147
(270) 348-2734
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
011226
KY
Other
Enumeration date
11/10/2020
Last updated
11/10/2020
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