Provider Demographics
NPI:1447793625
Name:REASER, JACOB CHARLES (PHARMD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:CHARLES
Last Name:REASER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 HENDERSON RD
Mailing Address - Street 2:APT 304
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-4049
Mailing Address - Country:US
Mailing Address - Phone:610-844-3285
Mailing Address - Fax:
Practice Address - Street 1:1113 W UNION BLVD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-3511
Practice Address - Country:US
Practice Address - Phone:610-844-3285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0672801835P2201X
MAPH2360791835P2201X
PARP4512111835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY067280OtherNEW YORK PHARMACIST LICENSE
PARP451211OtherPENNSYLVANIA PHARMACIST LICENSE
MAPH236079OtherMASSACHUSETTS PHARMACIST LICENSE