Healthcare Provider Details

I. General information

NPI: 1114404225
Provider Name (Legal Business Name): ASHTON LEIGH JENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CARLETON RD
HILLSDALE MI
49242-1048
US

IV. Provider business mailing address

104 RUTH ST APT 2
PITTSBURGH PA
15211-2308
US

V. Phone/Fax

Practice location:
  • Phone: 517-437-3373
  • Fax:
Mailing address:
  • Phone: 814-573-2232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302046557
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP452787
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: