Individual
KAYLA DANIELLE JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
255 OLD CAPITAL PLZ NW, CORYDON, IN 47112-2081
(812) 738-7191
(812) 738-0642
Mailing address
255 OLD CAPITAL PLZ NW, CORYDON, IN 47112-2081
(812) 738-7191
(812) 738-0642
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
016807
KY
183500000X
Pharmacist
Primary
26025144A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659474385
—
IN
01
—
311186877
FEDERAL TAX ID
IN
Enumeration date
03/20/2021
Last updated
03/20/2021
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