Provider Demographics
NPI:1518966159
Name:JENKINS, PHILLIP R (RPH)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:R
Last Name:JENKINS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12740 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-7224
Mailing Address - Country:US
Mailing Address - Phone:205-345-0785
Mailing Address - Fax:
Practice Address - Street 1:12740 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-7224
Practice Address - Country:US
Practice Address - Phone:205-345-0785
Practice Address - Fax:205-330-2430
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist