Provider Demographics
NPI:1548562572
Name:JENKINS, KENNETH RUSSELL (PHARMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:RUSSELL
Last Name:JENKINS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 N ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20374-5162
Mailing Address - Country:US
Mailing Address - Phone:202-225-5421
Mailing Address - Fax:202-226-8469
Practice Address - Street 1:915 N ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20374-5162
Practice Address - Country:US
Practice Address - Phone:202-225-5421
Practice Address - Fax:202-226-8469
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02905000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist