Provider Demographics
NPI:1730458134
Name:CESSNA, JASMINE ALICE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:ALICE
Last Name:CESSNA
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 1:915 WEST NORTHERN AVE.
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004
Mailing Address - Country:US
Mailing Address - Phone:719-545-1811
Mailing Address - Fax:719-545-3878
Practice Address - Street 1:915 WEST NORTHERN AVE.
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004
Practice Address - Country:US
Practice Address - Phone:719-545-1811
Practice Address - Fax:719-545-3878
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA0019557183500000X
IA21568183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist