Provider Demographics
NPI:1093928319
Name:JENKINS, WESLEY KEVIN
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:KEVIN
Last Name:JENKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 COLUMBIA HWY STE D
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-1175
Mailing Address - Country:US
Mailing Address - Phone:270-299-2467
Mailing Address - Fax:
Practice Address - Street 1:407 COLUMBIA HWY STE D
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-1175
Practice Address - Country:US
Practice Address - Phone:270-299-2467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY011821OtherKY STATE PHARMACIST LIC.