Provider Demographics
NPI:1093209801
Name:JENCO, PATRICIA MARY (RPH)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MARY
Last Name:JENCO
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 1:898 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4625
Mailing Address - Country:US
Mailing Address - Phone:203-929-7235
Mailing Address - Fax:203-929-3999
Practice Address - Street 1:898 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4625
Practice Address - Country:US
Practice Address - Phone:203-929-7235
Practice Address - Fax:203-929-3999
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist