Provider Demographics
NPI:1619256237
Name:JENSEN, CHERYL ELIZABETH CONNER (BPHARM)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ELIZABETH CONNER
Last Name:JENSEN
Suffix:
Gender:F
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8825 34TH AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:TULALIP
Mailing Address - State:WA
Mailing Address - Zip Code:98271-8085
Mailing Address - Country:US
Mailing Address - Phone:360-716-2660
Mailing Address - Fax:360-716-3660
Practice Address - Street 1:8825 34TH AVE NE STE A
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-8085
Practice Address - Country:US
Practice Address - Phone:360-716-2660
Practice Address - Fax:360-716-3660
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000162201835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist