Provider Demographics
NPI:1831555671
Name:JENKINS, RICKY
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 COUNTY ROAD 645
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75442-6979
Mailing Address - Country:US
Mailing Address - Phone:214-684-5681
Mailing Address - Fax:
Practice Address - Street 1:1225 STATE HIGHWAY 276
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-9376
Practice Address - Country:US
Practice Address - Phone:972-772-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-09
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28596OtherTEXAS STATE BOARD OF PHARMACY