Provider Demographics
NPI:1235716408
Name:DANIELS, JASMINE L
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:L
Last Name:DANIELS
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 1:850 CRAWFORD PKWY APT 6306
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2333
Mailing Address - Country:US
Mailing Address - Phone:757-632-9681
Mailing Address - Fax:
Practice Address - Street 1:632 GRASSFIELD PKWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7449
Practice Address - Country:US
Practice Address - Phone:757-312-9375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230033505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist