Provider Demographics
NPI:1770885485
Name:MILLS, JASMINE LATRICE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:LATRICE
Last Name:MILLS
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 1:11701 BELCHER RD S STE 128
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-5117
Mailing Address - Country:US
Mailing Address - Phone:727-523-2516
Mailing Address - Fax:
Practice Address - Street 1:11701 BELCHER RD S STE 128
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5117
Practice Address - Country:US
Practice Address - Phone:727-523-2515
Practice Address - Fax:727-523-2539
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist