Provider Demographics
NPI:1679996680
Name:JENSEN, STANLEY (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8071 GUIDE MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-9236
Mailing Address - Country:US
Mailing Address - Phone:360-318-0688
Mailing Address - Fax:
Practice Address - Street 1:8071 GUIDE MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9236
Practice Address - Country:US
Practice Address - Phone:360-318-0688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist