Provider Demographics
NPI:1427168988
Name:MACKENZIE-JENKINS, JILL ANNE (RPH)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:ANNE
Last Name:MACKENZIE-JENKINS
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 1:400 S POINTE DR APT 609
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-7300
Mailing Address - Country:US
Mailing Address - Phone:305-720-7069
Mailing Address - Fax:305-365-8312
Practice Address - Street 1:604 CRANDON BLVD
Practice Address - Street 2:
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-2026
Practice Address - Country:US
Practice Address - Phone:305-218-6100
Practice Address - Fax:305-365-8312
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0027680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050976Medicare ID - Type Unspecified