Provider Demographics
NPI:1932543972
Name:CROCKETT, JASMINE J (PHARMD)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:J
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:J
Other - Last Name:PECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3009 RUSSELL PKWY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8657
Mailing Address - Country:US
Mailing Address - Phone:478-333-7026
Mailing Address - Fax:478-333-7029
Practice Address - Street 1:3009 RUSSELL PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8657
Practice Address - Country:US
Practice Address - Phone:478-333-7026
Practice Address - Fax:478-333-7029
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026322183500000X
FLPS47997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist