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Individual

ALAN JENSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
590 E 17TH ST, IDAHO FALLS, ID 83404-6154
(208) 523-1090
(208) 528-8681
Mailing address
590 E 17TH ST, IDAHO FALLS, ID 83404-6154
(208) 523-1090

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P4239
ID

Other

Enumeration date
07/05/2011
Last updated
07/05/2011
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