Provider Demographics
NPI:1215359757
Name:JENSEN, SOPHIA MARTINEZ (RPH)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:MARTINEZ
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 1:2022 W MITCHELL DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5715
Mailing Address - Country:US
Mailing Address - Phone:602-451-9284
Mailing Address - Fax:602-243-8520
Practice Address - Street 1:6150 S 35TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5004
Practice Address - Country:US
Practice Address - Phone:602-243-8517
Practice Address - Fax:602-243-8520
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2014-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist