Provider Demographics
NPI:1386348605
Name:NELSON, JAZMIN ANN (CPHT)
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:ANN
Last Name:NELSON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15906-3212
Mailing Address - Country:US
Mailing Address - Phone:814-248-1649
Mailing Address - Fax:
Practice Address - Street 1:114 GILBERT ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15906-3212
Practice Address - Country:US
Practice Address - Phone:814-248-1649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
30186098183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
30186098OtherPHARMACY TECHNICIAN LICENSING BOARD