Provider Demographics
NPI:1750471744
Name:JENKINS, ANGELA D (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:D
Last Name:JENKINS
Suffix:
Gender:F
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:PO BOX 32861
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28232-2861
Mailing Address - Country:US
Mailing Address - Phone:704-987-2566
Mailing Address - Fax:704-987-2585
Practice Address - Street 1:16455 STATESVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7135
Practice Address - Country:US
Practice Address - Phone:704-987-2566
Practice Address - Fax:704-987-2585
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist