Provider Demographics
NPI:1881821833
Name:JENKS, LAURA BETH (PHAR D)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:BETH
Last Name:JENKS
Suffix:
Gender:F
Credentials:PHAR D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 BLUFF CITY HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620
Mailing Address - Country:US
Mailing Address - Phone:423-764-4136
Mailing Address - Fax:423-764-5167
Practice Address - Street 1:310 BLUFF CITY HIGHWAY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-764-4136
Practice Address - Fax:423-764-5167
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist