Provider Demographics
NPI:1164143939
Name:AMAYA, JASMIN AILEEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:AILEEN
Last Name:AMAYA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JASMIN
Other - Middle Name:AILEEN
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10536 OLGA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-1945
Mailing Address - Country:US
Mailing Address - Phone:915-490-2423
Mailing Address - Fax:
Practice Address - Street 1:9498 GATEWAY BLVD N
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-6808
Practice Address - Country:US
Practice Address - Phone:915-730-6092
Practice Address - Fax:915-730-6092
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist