Healthcare Provider Details

I. General information

NPI: 1851057699
Provider Name (Legal Business Name): DANA ELIZABETH JENKINS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 ENTERPRISE WAY SE STE 105
MARIETTA GA
30067-9220
US

IV. Provider business mailing address

1750 ENTERPRISE WAY SE STE 105
MARIETTA GA
30067-9220
US

V. Phone/Fax

Practice location:
  • Phone: 770-635-3301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH031337
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: