Provider Demographics
NPI:1558963272
Name:FITZGERALD, JASMINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:FITZGERALD
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:PO BOX 66072
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6072
Mailing Address - Country:US
Mailing Address - Phone:504-609-0221
Mailing Address - Fax:
Practice Address - Street 1:5801 MAIN ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4028
Practice Address - Country:US
Practice Address - Phone:225-654-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59567183500000X
MS14013183500000X
LA022769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist