Provider Demographics
NPI:1528784972
Name:WADE-DAVIS, JAZMIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAZMIN
Middle Name:
Last Name:WADE-DAVIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9821 RESEARCH DR APT 4133
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-5676
Mailing Address - Country:US
Mailing Address - Phone:704-453-4447
Mailing Address - Fax:
Practice Address - Street 1:5230 POPLAR TENT RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7757
Practice Address - Country:US
Practice Address - Phone:704-784-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist