MEDICARE: JOHN DAVID JENKINS 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	10519-040	WI

General Provider Information

NPI Number	:	1396021358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DAVID JENKINS RPH.

Provider Business Mailing Address
First Line	:	407 W LLOYD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-3120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 W OKLAHOMA AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-4718
Country	:	US
Telephone Number	:	414-744-1135
Fax Number	:

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

Provider Enumeration Date	:	10/21/2011
Last Update Date	:	10/21/2011

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