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General NPI Number Information
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NPI Number | 1235406133
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Entity Type | Individual
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Provider Name | MR. LUCIUS JENKINS
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Gender | Male
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Dates
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Enumeration Date | 11/20/2011
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Last Update Date | 11/20/2011
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Provider Practice Location Address
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Address Line | 1633 W 95TH ST
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City | CHICAGO
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State | IL
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Zip | 60643-1331
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Country | US
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Telephone | 773-445-9277
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Fax | 773-445-3015
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Provider Business Mailing Address
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Address Line | 9808 S BEVERLY AVE
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City | CHICAGO
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State | IL
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Zip | 60643-1377
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Country | US
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Telephone | 773-575-1031
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Fax | 773-238-3472
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051035486
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License Number State | IL
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