Provider Demographics
NPI:1265210215
Name:MY CONCIERGE PHARMACY PLLC
Entity type:Organization
Organization Name:MY CONCIERGE PHARMACY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS-KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:561-284-6165
Mailing Address - Street 1:2112 S CONGRESS AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7670
Mailing Address - Country:US
Mailing Address - Phone:561-284-6165
Mailing Address - Fax:561-284-6195
Practice Address - Street 1:2112 S CONGRESS AVE STE 207
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-7670
Practice Address - Country:US
Practice Address - Phone:561-284-6165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy