Provider Demographics
NPI:1801414701
Name:LEWIS, JASMINE (RPH)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5675 ROSWELL RD APT 14A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1215
Mailing Address - Country:US
Mailing Address - Phone:720-441-6179
Mailing Address - Fax:
Practice Address - Street 1:4535 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3100
Practice Address - Country:US
Practice Address - Phone:404-236-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist