Provider Demographics
NPI:1063037117
Name:BRACKEN, JASMINE K
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:K
Last Name:BRACKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13515 SOUTHWEST FWY STE 208
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3547
Mailing Address - Country:US
Mailing Address - Phone:937-304-1216
Mailing Address - Fax:
Practice Address - Street 1:13515 SOUTHWEST FWY STE 208
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3547
Practice Address - Country:US
Practice Address - Phone:937-304-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy