Provider Demographics
NPI:1508995861
Name:JENSEN, JERRY L (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:L
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 2ND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-4429
Mailing Address - Country:US
Mailing Address - Phone:308-234-8056
Mailing Address - Fax:308-234-8060
Practice Address - Street 1:2706 2ND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-4429
Practice Address - Country:US
Practice Address - Phone:308-234-8056
Practice Address - Fax:308-234-8060
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist