Provider Demographics
NPI:1790093268
Name:JENKINS, PATRICIA ROYALS (PD)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ROYALS
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:STAR CITY
Mailing Address - State:AR
Mailing Address - Zip Code:71667-4211
Mailing Address - Country:US
Mailing Address - Phone:870-628-5914
Mailing Address - Fax:870-628-6359
Practice Address - Street 1:1309 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:STAR CITY
Practice Address - State:AR
Practice Address - Zip Code:71667-4211
Practice Address - Country:US
Practice Address - Phone:870-628-5914
Practice Address - Fax:870-628-6359
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist