Individual
DR. KENNETH ALLEN JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
18500 GRAND RIVER AVE, DETROIT, MI 48223-2319
(313) 272-5256
(313) 272-9780
Mailing address
7517 DANBURY DR, WEST BLOOMFIELD, MI 48322-3564
(248) 895-0216
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5302024203
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5302024203
PHARMACY LICENSE NUMBER
MI
Enumeration date
04/13/2007
Last updated
10/02/2013
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