Provider Demographics
NPI:1043997133
Name:KIESOW, JENSEN RAE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JENSEN
Middle Name:RAE
Last Name:KIESOW
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 N CAREER AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57107-1348
Mailing Address - Country:US
Mailing Address - Phone:913-609-1914
Mailing Address - Fax:
Practice Address - Street 1:2701 N CAREER AVE APT 206
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57107-1348
Practice Address - Country:US
Practice Address - Phone:913-609-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD7058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist