MEDICARE: JENSEN PAUL MARSHALL PHARM. D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	47614	TX

General Provider Information

NPI Number	:	1861797037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENSEN PAUL MARSHALL PHARM. D

Provider Business Mailing Address
First Line	:	1200 N LOOP 336 W
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-1001
Country	:	US
Telephone Number	:	936-760-4116
Fax Number	:	936-760-4071

Provider Business Practice Location Address
First Line	:	1200 N LOOP 336 W
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-1001
Country	:	US
Telephone Number	:	936-760-4116
Fax Number	:	936-760-4071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2011
Last Update Date	:	01/20/2011

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