Organization
THE PANTRY RAIDER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY JACOBS RD (OWNER)
(404) 661-6781
Entity
Organization
Contact information
Practice address
3331 SUMMIT BLVD APT 16, PENSACOLA, FL 32503-4320
(404) 661-6781
Mailing address
3331 SUMMIT BLVD APT 16, PENSACOLA, FL 32503-4320
(404) 661-6781
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND5745
FL
Other
Enumeration date
04/15/2011
Last updated
04/15/2011
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