Healthcare Provider Details

I. General information

NPI: 1366333981
Provider Name (Legal Business Name): ALYSSA JENKINS RPH, PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 WESTFIELD RD
NOBLESVILLE IN
46060-1425
US

IV. Provider business mailing address

395 WESTFIELD RD
NOBLESVILLE IN
46060-1425
US

V. Phone/Fax

Practice location:
  • Phone: 317-776-7375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26027371A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: