Provider Demographics
NPI:1861005118
Name:CECIL, JASMINE JONATHAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:JONATHAN
Last Name:CECIL
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 1:4701 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-3907
Mailing Address - Country:US
Mailing Address - Phone:812-464-3656
Mailing Address - Fax:
Practice Address - Street 1:4701 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-3907
Practice Address - Country:US
Practice Address - Phone:812-464-3656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42533183500000X
GARPH031245183500000X
IN26028015A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN42533OtherTN LICENSE
GARPH031245OtherGA PHARMACY LICENSE
26028015AOtherIN LICENSE PHARMACIST