Provider Demographics
NPI:1427664713
Name:GEORGE, JASMINE (AE-C)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 GRAND AVE BSMT PHARMACY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-7886
Mailing Address - Country:US
Mailing Address - Phone:718-518-5020
Mailing Address - Fax:718-518-5298
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:MAIN BASEMENT PHARMACY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-518-5020
Practice Address - Fax:718-518-5298
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0574601835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist