Provider Demographics
NPI:1285336958
Name:DASHIELL, JAZMIN MARIE
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:MARIE
Last Name:DASHIELL
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 1:15344 CARROLLTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-2304
Mailing Address - Country:US
Mailing Address - Phone:757-635-0614
Mailing Address - Fax:757-238-9406
Practice Address - Street 1:13554 CARROLLTON BLVD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-3210
Practice Address - Country:US
Practice Address - Phone:757-238-9401
Practice Address - Fax:757-238-9406
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0230035276183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician