Provider Demographics
NPI:1295864940
Name:JENSEN, GILLIAN A (RPH, BS)
Entity Type:Individual
Prefix:MRS
First Name:GILLIAN
Middle Name:A
Last Name:JENSEN
Suffix:
Gender:F
Credentials:RPH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37807 CAMP CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-9762
Mailing Address - Country:US
Mailing Address - Phone:541-741-3937
Mailing Address - Fax:541-741-0715
Practice Address - Street 1:1521 MOHAWK BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3355
Practice Address - Country:US
Practice Address - Phone:541-687-7633
Practice Address - Fax:541-741-0715
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0007964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist