Healthcare Provider Details

I. General information

NPI: 1437270816
Provider Name (Legal Business Name): JENSEN DRUG & FLORAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 S MAIN
GUNNISON UT
84634-0807
US

IV. Provider business mailing address

PO BOX 789
GUNNISON UT
84634-0789
US

V. Phone/Fax

Practice location:
  • Phone: 435-528-3455
  • Fax: 435-528-3776
Mailing address:
  • Phone: 435-528-3455
  • Fax: 435-528-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1282321703
License Number StateUT

VIII. Authorized Official

Name: REDGE JENSEN
Title or Position: PRES
Credential:
Phone: 435-528-3455