Provider Demographics
NPI:1427359702
Name:THOMAS, JASMINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:
Last Name:THOMAS
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 1:1502 BENSON ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3102
Mailing Address - Country:US
Mailing Address - Phone:847-977-5435
Mailing Address - Fax:
Practice Address - Street 1:800 NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:FOX RIVER GROVE
Practice Address - State:IL
Practice Address - Zip Code:60021-1208
Practice Address - Country:US
Practice Address - Phone:847-516-8476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist