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General NPI Number Information
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NPI Number | 1851816391
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Entity Type | Individual
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Provider Name | THOMAS ROBERT JORGENSEN
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Gender | Male
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Dates
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Enumeration Date | 08/05/2017
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Last Update Date | 08/05/2017
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Provider Practice Location Address
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Address Line | 200 ROOD AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-7819
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Country | US
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Telephone | 970-241-2278
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 G RD APT 7D
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City | GRAND JUNCTION
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State | CO
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Zip | 81506-1408
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Country | US
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Telephone | 605-610-6664
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0021855
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License Number State | CO
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