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General NPI Number Information
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NPI Number | 1851611677
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Entity Type | Individual
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Provider Name | PAULENE T JASUREK RPH
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Gender | Female
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 4454 CYPRESS GARDENS RD
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City | WINTER HAVEN
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State | FL
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Zip | 33884
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Country | US
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Telephone | 863-318-8656
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Fax | 863-318-1797
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Provider Business Mailing Address
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Address Line | 4454 CYPRESS GARDENS BLVD
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City | WINTER HAVEN
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State | FL
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Zip | 33884-8656
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Country | US
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Telephone | 863-324-0121
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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 | PS0029907
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 046488-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PCT0008282
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License Number State | CT
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