| Provider / Organization | NPI | Date Certified |
|---|---|---|
| ALIDA JACOB | 1063005734 | 2021-02-14 |
Alida Jacob is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1063005734. Registration indicates Alida Jacob is a provider of services with a specialization in Pharmacy Service Providers, Pharmacist (Pharmacist, ) (Pharmacist, Pharmacy Service Providers)
| Entity Type | Individual |
| Provider Name | Alida Jacob |
| Practice Office Address | 4880 CENTRAL AVE NE HILLTOP, MN US |
| Practice Office Telephone | 7635717195 |
| Mailing Address | 4880 CENTRAL AVE NE HILLTOP, MN 554212630 US |
| Business Telephone | 7635717195 |
| Code | Practice | License No State |
|---|---|---|
| 183500000X PRIMARY | Pharmacy Service Providers Pharmacist Pharmacist Pharmacist Pharmacy Service Providers | 123692
MN |