Provider Demographics
NPI:1972101392
Name:COLLINS, JASMINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:
Last Name:COLLINS
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 1:6201 OAKENGATE DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3030
Mailing Address - Country:US
Mailing Address - Phone:757-613-6416
Mailing Address - Fax:
Practice Address - Street 1:3249 TYRE NECK RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3328
Practice Address - Country:US
Practice Address - Phone:757-483-9419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202215425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist