Provider Demographics
NPI:1689889677
Name:CORREY, JASMINE REYNOLDS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:REYNOLDS
Last Name:CORREY
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 1:8852 BENNINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7400 SPRING VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-4480
Practice Address - Country:US
Practice Address - Phone:703-923-4645
Practice Address - Fax:704-644-5972
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist