Provider Demographics
NPI:1720232440
Name:JENSON, ERIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:JENSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16200 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5833
Mailing Address - Country:US
Mailing Address - Phone:503-251-8995
Mailing Address - Fax:503-251-0253
Practice Address - Street 1:16200 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-5833
Practice Address - Country:US
Practice Address - Phone:503-251-8995
Practice Address - Fax:503-251-0253
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0011122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist