=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144409764
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANICE LYNN JENSEN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2007
-----------------------------------------------------
Last Update Date | 09/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12900 RIVERDALE DR NW
-----------------------------------------------------
City | COON RAPIDS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55448-1282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-421-0065
-----------------------------------------------------
Fax | 763-421-5908
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12900 RIVERDALE DR NW
-----------------------------------------------------
City | COON RAPIDS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55448-1282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-421-0065
-----------------------------------------------------
Fax | 763-421-5908
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 115771
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------