Provider Demographics
NPI:1699172312
Name:JENKINS, TENEAL FAYE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TENEAL
Middle Name:FAYE
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:P.O. BOX 65
Mailing Address - Street 2:101 WEST GORE AVE
Mailing Address - City:GAINESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38562-0065
Mailing Address - Country:US
Mailing Address - Phone:931-268-0233
Mailing Address - Fax:931-268-2183
Practice Address - Street 1:101 WEST GORE AVE
Practice Address - Street 2:
Practice Address - City:GAINESBORO
Practice Address - State:TN
Practice Address - Zip Code:38562-0065
Practice Address - Country:US
Practice Address - Phone:931-268-0233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000021783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist