Provider Demographics
NPI:1932487642
Name:JENSEN, KRISTIAN ARDIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:ARDIS
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 1:134 FALLING LEAF LN
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8336
Mailing Address - Country:US
Mailing Address - Phone:803-596-2290
Mailing Address - Fax:
Practice Address - Street 1:4520 HARD SCRABBLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8560
Practice Address - Country:US
Practice Address - Phone:803-419-7507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist