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General NPI Number Information
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NPI Number | 1700093150
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Entity Type | Individual
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Provider Name | JOHN ALLEN JENSEN SR. R.PH.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 621 G AVE
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City | GRUNDY CENTER
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State | IA
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Zip | 50638-1549
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Country | US
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Telephone | 319-824-5446
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Fax |
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Provider Business Mailing Address
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Address Line | 2622 RYAN DR
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City | CEDAR FALLS
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State | IA
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Zip | 50613-6642
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Country | US
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Telephone | 319-610-3299
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Fax |
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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 | 15650
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License Number State | IA
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