Provider Demographics
NPI:1326323023
Name:JENSEN, DANIEL RALPH (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RALPH
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 1:1311 DRAPER PKWY
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8567
Mailing Address - Country:US
Mailing Address - Phone:801-571-0378
Mailing Address - Fax:801-571-8406
Practice Address - Street 1:1311 DRAPER PKWY
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8567
Practice Address - Country:US
Practice Address - Phone:801-571-0378
Practice Address - Fax:801-571-8406
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5640029-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist