Provider Demographics
NPI:1437270816
Name:JENSEN DRUG & FLORAL INC
Entity Type:Organization
Organization Name:JENSEN DRUG & FLORAL INC
Other - Org Name:JENSEN DRUG AND FLORAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:REDGE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-528-3455
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:UT
Mailing Address - Zip Code:84634-0789
Mailing Address - Country:US
Mailing Address - Phone:435-528-3455
Mailing Address - Fax:435-528-3776
Practice Address - Street 1:77 S MAIN
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:UT
Practice Address - Zip Code:84634-0807
Practice Address - Country:US
Practice Address - Phone:435-528-3455
Practice Address - Fax:435-528-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
UT12823217033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876137280005Medicaid
4601515OtherNCPDP PROVIDER IDENTIFICATION NUMBER