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General NPI Number Information
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NPI Number | 1538715115
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Entity Type | Individual
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Provider Name | ANTHONY KEITH JENSEN RPH
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Gender | Male
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Dates
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Enumeration Date | 08/10/2019
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Last Update Date | 08/10/2019
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Provider Practice Location Address
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Address Line | 1709 E STATE HIGHWAY 54
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City | LINTON
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State | IN
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Zip | 47441-9589
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Country | US
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Telephone | 812-847-2226
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Fax |
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Provider Business Mailing Address
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Address Line | 10038 W STATE ROAD 154
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City | SULLIVAN
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State | IN
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Zip | 47882-7149
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Country | US
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Telephone | 502-500-0177
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Fax | 812-847-2146
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26026077A
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License Number State | IN
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