Provider Demographics
NPI:1609251586
Name:GROMILIC, JASMINA (PHARM D)
Entity Type:Individual
Prefix:
First Name:JASMINA
Middle Name:
Last Name:GROMILIC
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 NEW HARTFORD ST
Mailing Address - Street 2:3B
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13417-1585
Mailing Address - Country:US
Mailing Address - Phone:315-292-2822
Mailing Address - Fax:
Practice Address - Street 1:21B KNOLLS CRES
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-6301
Practice Address - Country:US
Practice Address - Phone:718-432-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist