MEDICARE: PAUL ALAN JENSEN R.PH.

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	5302024257	MI

General Provider Information

NPI Number	:	1972996296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ALAN JENSEN R.PH.

Provider Business Mailing Address
First Line	:	6971 9 MILE RD NE
Second Line	:
City	:	ROCKFORD
State	:	MI
Zip	:	49341-9633
Country	:	US
Telephone Number	:	616-690-3318
Fax Number	:

Provider Business Practice Location Address
First Line	:	6455 US HIGHWAY 31 N
Second Line	:
City	:	WILLIAMSBURG
State	:	MI
Zip	:	49690-9306
Country	:	US
Telephone Number	:	231-938-1181
Fax Number	:

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

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	03/11/2015

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