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General NPI Number Information
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NPI Number | 1831555671
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Entity Type | Individual
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Provider Name | RICKY JENKINS
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Gender | Male
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Dates
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Enumeration Date | 01/09/2016
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Last Update Date | 01/09/2016
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Provider Practice Location Address
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Address Line | 1225 STATE HIGHWAY 276
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City | ROCKWALL
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State | TX
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Zip | 75032-9376
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Country | US
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Telephone | 972-772-1609
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Fax |
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Provider Business Mailing Address
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Address Line | 2231 COUNTY ROAD 645
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City | FARMERSVILLE
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State | TX
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Zip | 75442-6979
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Country | US
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Telephone | 214-684-5681
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Fax |
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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 | 28596
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License Number State | TX
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