Provider Demographics
NPI:1750488391
Name:JENSEN, CHUCK RONALD (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:CHUCK
Middle Name:RONALD
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 1:4513 NE 25TH CT
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3533
Mailing Address - Country:US
Mailing Address - Phone:425-235-6672
Mailing Address - Fax:
Practice Address - Street 1:17801 108TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6420
Practice Address - Country:US
Practice Address - Phone:425-235-5383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist