Individual
CLAYTON JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1604 W BROADWAY ST, IDAHO FALLS, ID 83402-3048
(208) 522-4655
Mailing address
1604 W BROADWAY ST, IDAHO FALLS, ID 83402-3048
(208) 522-4655
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P8208
ID
Other
Enumeration date
03/17/2019
Last updated
03/17/2019
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