MEDICARE: DEANDREA RESHAUN JENKINS PHARM TECH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1093913725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANDREA RESHAUN JENKINS PHARM TECH

Provider Business Mailing Address
First Line	:	4207 CHESTWOOD CT APT 167
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-2479
Country	:	US
Telephone Number	:	813-748-0066
Fax Number	:

Provider Business Practice Location Address
First Line	:	4207 CHESTWOOD CT APT 167
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-2479
Country	:	US
Telephone Number	:	813-748-0066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	07/08/2007

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