Provider Demographics
NPI:1851611677
Name:JASUREK, PAULENE T (RPH)
Entity Type:Individual
Prefix:MS
First Name:PAULENE
Middle Name:T
Last Name:JASUREK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:PAOLING
Other - Middle Name:
Other - Last Name:TSOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4454 CYPRESS GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-8656
Mailing Address - Country:US
Mailing Address - Phone:863-324-0121
Mailing Address - Fax:
Practice Address - Street 1:4454 CYPRESS GARDENS RD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884
Practice Address - Country:US
Practice Address - Phone:863-318-8656
Practice Address - Fax:863-318-1797
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0029907183500000X
NY046488-1183500000X
CTPCT0008282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist