Provider Demographics
NPI:1750806220
Name:LORICK, JASMINE MARIE TAGUPA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:MARIE TAGUPA
Last Name:LORICK
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 1:804 FALLS BLVD S
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-3505
Mailing Address - Country:US
Mailing Address - Phone:870-238-7085
Mailing Address - Fax:870-238-9750
Practice Address - Street 1:804 FALLS BLVD S
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3505
Practice Address - Country:US
Practice Address - Phone:870-238-7085
Practice Address - Fax:870-238-9750
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist