Provider Demographics
NPI:1821584996
Name:JASIM, MAJID J (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MAJID
Middle Name:J
Last Name:JASIM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9317 GUTENBERG RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-4101
Mailing Address - Country:US
Mailing Address - Phone:502-345-0389
Mailing Address - Fax:
Practice Address - Street 1:10 CHARBY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649-7901
Practice Address - Country:US
Practice Address - Phone:606-285-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY019744OtherPHARMACIST