Provider Demographics
NPI:1891082525
Name:JENSEN, SONYA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:M
Last Name:JENSEN
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 1:230 MOREHEAD ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2325
Mailing Address - Country:US
Mailing Address - Phone:402-490-4765
Mailing Address - Fax:
Practice Address - Street 1:230 MOREHEAD ST
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2325
Practice Address - Country:US
Practice Address - Phone:308-432-2070
Practice Address - Fax:308-432-9655
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE13654OtherPHARMACIST LICENSE NUMBER-NE DHHS