MEDICARE: MRS. KENDA KAY JEFFERSON RPH

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	03-2-19467	OH

General Provider Information

NPI Number	:	1023190410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KENDA KAY JEFFERSON RPH

Provider Business Mailing Address
First Line	:	7265 MADISON CIR
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-5161
Country	:	US
Telephone Number	:	770-964-9379
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 HARDEE AVE SW
Second Line	:	ATTN: PHARMACY SERVICE
City	:	FT. MCPHERSON
State	:	GA
Zip	:	30330-1062
Country	:	US
Telephone Number	:	404-464-0296
Fax Number	:	404-464-0303

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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