Individual
LARRY CARLTON JENKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
912 HIGHWAY 15, STRINGER, MS 39481-4230
(601) 649-4418
(601) 649-4487
Mailing address
912 HIGHWAY 15, PO BOX 128, STRINGER, MS 39481-0128
(601) 649-4418
(601) 649-4487
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
05068/11.1
MS
3336S0011X
Specialty Pharmacy
05321/02.5
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330648
—
MS
05
—
00440829
—
MS
01
—
1700073905
MEDICARE NPI
MS
Enumeration date
07/11/2006
Last updated
03/28/2008
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