Provider Demographics
NPI:1952745481
Name:DEITSCH, JACOB PHILIP-REID (PHARMD, BCPS)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:PHILIP-REID
Last Name:DEITSCH
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15529 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2182 DIVIDEND DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228
Practice Address - Country:US
Practice Address - Phone:844-386-2472
Practice Address - Fax:888-776-5018
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020469183500000X
OH03233825183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist