MEDICARE: KENNETH RUSSELL JENKINS PHARMD

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	183500000X	Pharmacist	28RI02905000	NJ

General Provider Information

NPI Number	:	1548562572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH RUSSELL JENKINS PHARMD

Provider Business Mailing Address
First Line	:	915 N ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20374-5162
Country	:	US
Telephone Number	:	202-225-5421
Fax Number	:	202-226-8469

Provider Business Practice Location Address
First Line	:	915 N ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20374-5162
Country	:	US
Telephone Number	:	202-225-5421
Fax Number	:	202-226-8469

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

Provider Enumeration Date	:	11/24/2010
Last Update Date	:	04/10/2015

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