MEDICARE: JENSEN SARAE KORNOKOVICH PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26028881A	IN

General Provider Information

NPI Number	:	1083219869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENSEN SARAE KORNOKOVICH PHARMD

Provider Business Mailing Address
First Line	:	421 E MARKET ST APT 117
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-2860
Country	:	US
Telephone Number	:	303-249-0395
Fax Number	:

Provider Business Practice Location Address
First Line	:	5026 W US 52
Second Line	:
City	:	NEW PALESTINE
State	:	IN
Zip	:	46163-9770
Country	:	US
Telephone Number	:	317-861-4838
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/01/2020

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