Individual
MR. KENNETH WESLEY JASCOMB
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1000 JOHNSON FERRY RD NE, ATLANTA, GA 30342-1606
(404) 851-6265
Mailing address
1677 BAYWOOD CT, LAWRENCEVILLE, GA 30043-6932
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH014048
GA
Other
Enumeration date
09/08/2005
Last updated
07/08/2007
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