Provider Demographics
NPI:1457741878
Name:JENKS, KATHI (RPH)
Entity Type:Individual
Prefix:
First Name:KATHI
Middle Name:
Last Name:JENKS
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 1:19869 SEA BLOSSOM BLVD
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-7142
Mailing Address - Country:US
Mailing Address - Phone:302-226-7791
Mailing Address - Fax:302-226-7796
Practice Address - Street 1:19869 SEA BLOSSOM BLVD
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-7142
Practice Address - Country:US
Practice Address - Phone:302-226-7791
Practice Address - Fax:302-226-7796
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14831183500000X
DEA1-0003129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist