Provider Demographics
NPI:1013081579
Name:JENSEN, JUANA M (RPH)
Entity Type:Individual
Prefix:MS
First Name:JUANA
Middle Name:M
Last Name:JENSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 ANTHEM VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5504
Mailing Address - Country:US
Mailing Address - Phone:702-617-4526
Mailing Address - Fax:702-617-8974
Practice Address - Street 1:2511 ANTHEM VILLAGE DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5504
Practice Address - Country:US
Practice Address - Phone:702-617-4526
Practice Address - Fax:702-617-8974
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist