Provider Demographics
NPI:1306634969
Name:JENKINS, KONNOR MARIAH (PHARMD)
Entity type:Individual
Prefix:
First Name:KONNOR
Middle Name:MARIAH
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 WAYNE 404
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63944-8799
Mailing Address - Country:US
Mailing Address - Phone:573-944-3318
Mailing Address - Fax:
Practice Address - Street 1:1025 HIGHWAY 72 BYP
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-7326
Practice Address - Country:US
Practice Address - Phone:573-783-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024035075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist