MEDICARE: MS. PATRICIA ROYALS JENKINS PD

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	06133	AR

General Provider Information

NPI Number	:	1790093268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA ROYALS JENKINS PD

Provider Business Mailing Address
First Line	:	1309 N LINCOLN AVE
Second Line	:
City	:	STAR CITY
State	:	AR
Zip	:	71667-4211
Country	:	US
Telephone Number	:	870-628-5914
Fax Number	:	870-628-6359

Provider Business Practice Location Address
First Line	:	1309 N LINCOLN AVE
Second Line	:
City	:	STAR CITY
State	:	AR
Zip	:	71667-4211
Country	:	US
Telephone Number	:	870-628-5914
Fax Number	:	870-628-6359

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

Provider Enumeration Date	:	09/18/2010
Last Update Date	:	09/18/2010

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