Provider Demographics
NPI:1396098232
Name:MANSURI, JASMINE D (RPH)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:D
Last Name:MANSURI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-3808
Mailing Address - Country:US
Mailing Address - Phone:201-418-2830
Mailing Address - Fax:201-418-2834
Practice Address - Street 1:308 WILLOW AVENUE
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-1085
Practice Address - Country:US
Practice Address - Phone:201-418-2830
Practice Address - Fax:201-418-2834
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446510183500000X
NJ28RI03660000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist