Provider Demographics
NPI:1376092767
Name:ANDERSON, JASMINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 STEILACOOM BLVD SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-4716
Mailing Address - Country:US
Mailing Address - Phone:253-582-4149
Mailing Address - Fax:253-582-8664
Practice Address - Street 1:8611 STEILACOOM BLVD SW
Practice Address - Street 2:C/O PHARMACY DEPARTMENT
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-4716
Practice Address - Country:US
Practice Address - Phone:253-582-4149
Practice Address - Fax:253-582-8664
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60666226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist