Provider Demographics
NPI:1699819557
Name:JENSEN, MICHAEL KIRK (RPH, MS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KIRK
Last Name:JENSEN
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 N MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-1000
Mailing Address - Country:US
Mailing Address - Phone:801-585-6522
Mailing Address - Fax:
Practice Address - Street 1:65 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-1000
Practice Address - Country:US
Practice Address - Phone:801-585-6522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT150767-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist