Healthcare Provider Details

I. General information

NPI: 1598050478
Provider Name (Legal Business Name): JENNIFER LYNN TORBENSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LYNN GENTZ RPH

II. Dates (important events)

Enumeration Date: 06/18/2011
Last Update Date: 06/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 S KENSINGTON DR T-1248
APPLETON WI
54915-4136
US

IV. Provider business mailing address

1800 S KENSINGTON DR T-1248
APPLETON WI
54915-4136
US

V. Phone/Fax

Practice location:
  • Phone: 920-749-9775
  • Fax: 920-749-9775
Mailing address:
  • Phone: 920-749-9775
  • Fax: 920-749-9775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12315-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: