Provider Demographics
NPI:1598050478
Name:TORBENSON, JENNIFER LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:TORBENSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:GENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1800 S KENSINGTON DR
Mailing Address - Street 2:T-1248
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-4136
Mailing Address - Country:US
Mailing Address - Phone:920-749-9775
Mailing Address - Fax:920-749-9775
Practice Address - Street 1:1800 S KENSINGTON DR
Practice Address - Street 2:T-1248
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-4136
Practice Address - Country:US
Practice Address - Phone:920-749-9775
Practice Address - Fax:920-749-9775
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12315-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist