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NPI Code Detail

MEDICARE: SOPHIA MARTINEZ JENSEN RPH

MEDICARE: SOPHIA MARTINEZ JENSEN RPH
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
1183500000XPharmacistS017376AZ

General Provider Information

NPI Number : 1215359757
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHIA MARTINEZ JENSEN RPH
Provider Business Mailing Address
First Line : 2022 W MITCHELL DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-5715
Country : US
Telephone Number : 602-451-9284
Fax Number : 602-243-8520
Provider Business Practice Location Address
First Line : 6150 S 35TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85041-5004
Country : US
Telephone Number : 602-243-8517
Fax Number : 602-243-8520
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2014
Last Update Date : 01/18/2014

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