Provider Demographics
NPI:1801237334
Name:JENSEN, JOHN A JR (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:JENSEN
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19141 GOLDEN CACOON PL
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-9061
Mailing Address - Country:US
Mailing Address - Phone:813-926-2678
Mailing Address - Fax:
Practice Address - Street 1:19141 GOLDEN CACOON PL
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-9061
Practice Address - Country:US
Practice Address - Phone:813-926-2678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist