Active NPI
Mayla M Jenkins, CPHT
- Pharmacy Technician
- Minonk, IL
National Provider Identifier
1649938127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 049191444
- Practice address
- 1305 N Carolyn Dr
Minonk, IL 61760-9326 - Phone
- (309) 432-3451
- Fax
- (309) 432-3625
- NPI assigned
- Dec 2, 2021
- Last updated
- Dec 2, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 049191444 | IL | Primary |
Addresses
Primary practice location
1305 N Carolyn Dr
Minonk, IL 61760-9326
Mailing address
122 Saint James PL
Pontiac, IL 61764-2126
Phone (815) 579-8077
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 049191444 | IL | MD | Pharmacy Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Green Tree Pharmacy, Inc. | Current | Accepting new patients |
Locations
1305 N Carolyn Dr
Minonk, IL 61760
Phone (309) 432-3451
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638403200000",
"number": "1649938127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "122 SAINT JAMES PL",
"city": "PONTIAC",
"state": "IL",
"postal_code": "617642126",
"telephone_number": "815-579-8077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1305 N CAROLYN DR",
"city": "MINONK",
"state": "IL",
"postal_code": "617609326",
"telephone_number": "309-432-3451",
"fax_number": "309-432-3625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENKINS",
"first_name": "MAYLA",
"middle_name": "M",
"credential": "CPHT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-12-02",
"last_updated": "2021-12-02",
"certification_date": "2021-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "IL",
"license": "049191444",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minonk, IL
- Green Tree Pharmacy, Inc. (Green Tree Pharmacy)
- Jamie Harrison, PHARMD
- Neil Paul Heineke, PHARM D.
- Heritage Manor - Minonk, LLC (Heritage Health)
- Heritage Manor Minonk, LLC (Heritage Health - Minonk)
- Joseph Lutterbie, PHARMD
- Amy Naas
- Darcie Omiotek, SLP
- John E Podzamsky, DO
- Rebecca Bowen Reynolds, RPH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.