Provider Demographics
NPI:1225746548
Name:JUSTILIEN, JASMINE AMANDA (RPH)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:AMANDA
Last Name:JUSTILIEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5990 TOWNSEND RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4553
Mailing Address - Country:US
Mailing Address - Phone:904-771-1987
Mailing Address - Fax:904-783-9440
Practice Address - Street 1:5990 TOWNSEND RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-4553
Practice Address - Country:US
Practice Address - Phone:904-771-1987
Practice Address - Fax:904-783-9440
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist