Provider Demographics
NPI:1003482704
Name:JENSEN, KARLIE (RPH)
Entity Type:Individual
Prefix:
First Name:KARLIE
Middle Name:
Last Name:JENSEN
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 1:11506 S 4000 W
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-6070
Mailing Address - Country:US
Mailing Address - Phone:801-446-9995
Mailing Address - Fax:801-519-3423
Practice Address - Street 1:11506 S 4000 W
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-6070
Practice Address - Country:US
Practice Address - Phone:801-446-9995
Practice Address - Fax:801-519-3423
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7765292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist