Provider Demographics
NPI:1932831328
Name:ISAACSON, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:ISAACSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 W 500 N
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-3943
Mailing Address - Country:US
Mailing Address - Phone:801-513-8459
Mailing Address - Fax:
Practice Address - Street 1:2353 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:UT
Practice Address - Zip Code:84015-2454
Practice Address - Country:US
Practice Address - Phone:801-825-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9549963-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist