Provider Demographics
NPI:1780701706
Name:JENKINS, AMANDA PANETHONG
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:PANETHONG
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-3314
Mailing Address - Country:US
Mailing Address - Phone:610-733-1462
Mailing Address - Fax:484-826-0496
Practice Address - Street 1:400 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5412
Practice Address - Country:US
Practice Address - Phone:484-826-0434
Practice Address - Fax:484-826-0496
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician