Provider Demographics
NPI:1235930819
Name:TOLBERT, JASMINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:TOLBERT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 DECKBAR AVE APT 240
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-3931
Mailing Address - Country:US
Mailing Address - Phone:504-222-5453
Mailing Address - Fax:
Practice Address - Street 1:300 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4112
Practice Address - Country:US
Practice Address - Phone:318-219-9554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist