Healthcare Provider Details

I. General information

NPI: 1447884960
Provider Name (Legal Business Name): JENSEN CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 LEE ST
CHARLOTTESVILLE VA
22908-0817
US

IV. Provider business mailing address

100 HURST LN APT 207
CHARLOTTESVILLE VA
22903-6411
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-2390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0202215887
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: