Provider Demographics
NPI:1043592942
Name:JENSEN, CHRIS MATHEW (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:MATHEW
Last Name:JENSEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 OCOEE ST N
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4833
Mailing Address - Country:US
Mailing Address - Phone:423-472-8910
Mailing Address - Fax:423-472-5398
Practice Address - Street 1:4420 OCOEE ST N
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4833
Practice Address - Country:US
Practice Address - Phone:423-472-8910
Practice Address - Fax:423-472-5398
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist