DR. JACOB A MOCK (NPI# 1902032535) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902032535 |
| Entity Type | Individual |
| Full Name | DR. JACOB A MOCK |
| Other Name | JAKE A MOCK |
| Credential | PHARMD, BCGP |
| Practice Address |
2630 Central Ave Eielson Afb AK 99702-2301 |
| Practice Telephone | 9073776606 |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2019-03-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
RPH-0013183 | OR | Pharmacy Service Providers |
| N | 1835G0303X |
Pharmacist Specialization: Geriatric |
102058 | AK | Pharmacy Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1650 Cowles St, Fairbanks, AK 997015907 | 9074585615 |
| Street Address |
2630 CENTRAL AVE |
| City | EIELSON AFB |
| State | AK |
| Zip Code | 99702-2301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578545109 | Robert Greg Patterson | Family Medicine | 2630 Central Ave, Suite 1m07, Eielson Afb, AK 99702-2325 | 2005-11-18 |
| 1689274664 | Bradley Martin | Dental Hygienist | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2020-10-28 |
| 1891395802 | Kaleb Hatfield | Dental Hygienist | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2020-10-28 |
| 1346840329 | Stephanie Danielle Rowe | Dental Assistant | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2020-10-28 |
| 1851991855 | Cody Scott Lemon | Dental Hygienist | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2020-10-28 |
| 1578189387 | Eric Dylan Mason | Military Health Care Provider | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2020-06-18 |
| 1912546524 | Susan Liebig | Dental Hygienist | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2019-12-30 |
| 1639724636 | Sandra Muniz | Licensed Practical Nurse | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2019-08-06 |
| 1104393446 | Matthew Gray | Military Health Care Provider | 2630 Central Ave, Eielson Afb, AK 99702-2301 | 2018-10-24 |
| 1952885121 | Anthony Ewell-kollmann | Dentist | 2630 Central Ave, Eielson Afb, AK 99702 | 2018-09-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174864904 | Eric Noll | Optometrist | 2630 Central Ave # 3349, Eielson Afb, AK 99702 | 2013-03-04 |
| 1407125123 | Optical Center | Technician/Technologist | 451 Broadway Street, Eielson Afb Aafes Exchange, Eielson, AK 99702 | 2011-12-27 |
| 1063649234 | John Michael Strothenke | Military Health Care Provider | 2630 Central Avenue Suite 1, 354 Medical Operations Squadron, Clinical Medicine Flt, Eielson Air Force Base, AK 99702 | 2009-06-16 |
| 1225272073 | Landru Derek Medvec | Military Health Care Provider | 2422 Arctic Ave, Apt D, Eielson Afb, AK 99702 | 2009-04-23 |
| 1780875617 | Victoria L Ketchum | Specialist | E. Cowles, Fairbanks Memorial Hospital, Fairbanks, AK 99702 | 2007-08-06 |
| 1689768103 | Angie M. Walker | Social Worker | 2630 Central Av, Suite 1m07, Eielson Afb, AK 99702 | 2006-10-02 |
| 1306945464 | 354th Medical Group Mdg | Military/U.S. Coast Guard Pharmacy | Bldg 3349 Central Ave, Eielson Afb, AK 99702 | 2006-09-22 |
| 1760442297 | Susan Mary Runyan | Dietitian, Registered | 354th Medical Group, 2630 Central Ave, Suite 1m07, Eielson Afb, AK 99702 | 2006-03-27 |
| 1972166916 | Andrew Joseph Colburn | Registered Nurse | 2630 Central Ave # 3349, Eielson Afb, AK 99702 | 2019-04-16 |
| 1306375704 | Robert Marshall Walter | Dentist | 2630 Central Ave Bldg 3349, Eielson Afb, AK 99702 | 2017-06-08 |
| Find all providers in zip 99702 | ||||
| Taxonomy Code | 1835P0018X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |
| Notes: Source: National Uniform Claim Committee, 2007 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114263167 | Brian D Schilling | Pharmacist | Pcc Pharmacy, 4320 Diplomacy Dr, Anchorage, AK 99508-5925 | 2012-12-19 |
| 1093366601 | Heather Heidorn | Pharmacist | 528 Chief Eddie Hoffman Hwy, Bethel, AK 99559-0528 | 2019-09-25 |
| 1861043564 | Ashley Lourilea Hunsucker | Pharmacist | 700 Chief Eddie Hoffman Highway, Bethel, AK 99559 | 2019-09-24 |
| 1356990808 | Philip Quintero | Pharmacist | 1501 Huffman Rd, Anchorage, AK 99515-3596 | 2019-09-07 |
| 1780169094 | Michael Kristopher Frazier | Pharmacist | 1201 N Muldoon Rd, Anchorage, AK 99504-6104 | 2018-10-02 |
| 1932682127 | Devin Benjamin Drummond | Pharmacist | 1000 Greg Kruschek Ave, Nome, AK 99762 | 2018-09-13 |
| 1609379726 | Michael Bolan | Pharmacist | 4076 Neely Road, Fort Wainwright, AK 99709 | 2018-03-15 |
| 1093244287 | Lauren Elizabeth Kaleta | Pharmacist | 106 Lincoln St, Sitka, AK 99835-7540 | 2017-06-09 |
| 1164956421 | Stephen John Sullivan Jr. | Pharmacist | 5955 Zeamer Ave # 673mdg, Jber, AK 99506-3702 | 2017-04-13 |
| 1346608445 | Allorie Timon Caldwell | Pharmacist | 3200 Providence Dr, Anchorage, AK 99508-4615 | 2016-02-03 |
| Find all providers with the same taxonomy | ||||
| City | EIELSON AFB |
| Zip Code | 99702 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.