Provider Demographics
NPI:1144352758
Name:JORGENSEN, JUDITH M (RPH)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:M
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PLAINFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-5813
Mailing Address - Country:US
Mailing Address - Phone:860-745-9054
Mailing Address - Fax:
Practice Address - Street 1:19 PLAINFIELD ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-5813
Practice Address - Country:US
Practice Address - Phone:860-745-9054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5272183500000X
MA22373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist