Healthcare Provider Details

I. General information

NPI: 1578492385
Provider Name (Legal Business Name): JASMINE JOHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 EMERALD BAY RD
SOUTH LAKE TAHOE CA
96150-6210
US

IV. Provider business mailing address

PO BOX 283
CARSON CITY NV
89702-0283
US

V. Phone/Fax

Practice location:
  • Phone: 530-544-1445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: