Provider Demographics
NPI:1649955600
Name:NORRIS, JASMINE M
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:M
Last Name:NORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 CRESCENT POINTE PKWY APT 2303
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7394
Mailing Address - Country:US
Mailing Address - Phone:727-504-8821
Mailing Address - Fax:
Practice Address - Street 1:2350 BOONVILLE RD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77808-2225
Practice Address - Country:US
Practice Address - Phone:979-731-1401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43072183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician