Provider Demographics
NPI:1689059438
Name:JENSON, ALEXANDRA JAE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:JAE
Last Name:JENSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:JAE
Other - Last Name:BURNSIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2118 8TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-6150
Mailing Address - Country:US
Mailing Address - Phone:320-255-0054
Mailing Address - Fax:320-203-7561
Practice Address - Street 1:2118 8TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-6150
Practice Address - Country:US
Practice Address - Phone:320-255-0054
Practice Address - Fax:320-203-7561
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist