Provider Demographics
NPI:1598488124
Name:JENKINS, KASEY MADISON (PHARMD)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:MADISON
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 COUNTRY ROCK RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-8112
Mailing Address - Country:US
Mailing Address - Phone:919-225-3674
Mailing Address - Fax:
Practice Address - Street 1:124 COUNTRY ROCK RD
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-8112
Practice Address - Country:US
Practice Address - Phone:919-225-3674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist