Provider Demographics
NPI:1619556396
Name:JORGENSON, SARAH (RPH)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:JORGENSON
Suffix:
Gender:F
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:S4410 RYGG RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-9757
Mailing Address - Country:US
Mailing Address - Phone:715-590-4203
Mailing Address - Fax:
Practice Address - Street 1:3915 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-8166
Practice Address - Country:US
Practice Address - Phone:715-834-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11695-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11695-040OtherWISCONSIN PHARMACIST LICENSE