Provider Demographics
NPI:1073540530
Name:JENSEN, JEFFREY P (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:P
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:W336N6437 LAKEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-1926
Mailing Address - Country:US
Mailing Address - Phone:630-373-9371
Mailing Address - Fax:
Practice Address - Street 1:10201 W INNOVATION DR
Practice Address - Street 2:SUITE 600
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4822
Practice Address - Country:US
Practice Address - Phone:414-410-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9886183500000X
CO12348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist