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General NPI Number Information
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NPI Number | 1609662881
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Entity Type | Individual
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Provider Name | JASMYN ELLISON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 1000 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6708
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Country | US
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Telephone | 850-862-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 2004 98 PALMS BLVD UNIT 4121
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City | DESTIN
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State | FL
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Zip | 32541-2775
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Country | US
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Telephone | 678-481-5377
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS64586
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License Number State | FL
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