Healthcare Provider Details

I. General information

NPI: 1831052109
Provider Name (Legal Business Name): BENJAMIN JORGENSEN PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 10TH ST N
NORTHWOOD IA
50459-1438
US

IV. Provider business mailing address

98 10TH ST N
NORTHWOOD IA
50459-1438
US

V. Phone/Fax

Practice location:
  • Phone: 641-324-2116
  • Fax: 641-324-1032
Mailing address:
  • Phone: 641-324-2116
  • Fax: 641-324-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23043
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: