MEDICARE: PHILLIP R 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	6954	AL

General Provider Information

NPI Number	:	1518966159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP R JENKINS RPH

Provider Business Mailing Address
First Line	:	12740 COUNTRY LN
Second Line	:
City	:	NORTHPORT
State	:	AL
Zip	:	35473-7224
Country	:	US
Telephone Number	:	205-345-0785
Fax Number	:

Provider Business Practice Location Address
First Line	:	12740 COUNTRY LN
Second Line	:
City	:	NORTHPORT
State	:	AL
Zip	:	35473-7224
Country	:	US
Telephone Number	:	205-345-0785
Fax Number	:	205-330-2430

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

Provider Enumeration Date	:	07/16/2005
Last Update Date	:	07/08/2007

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