Active NPI
Clint L Jensen, PHARM.D.
- Pharmacist
- Chubbuck, ID
National Provider Identifier
1114200599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P4731
- Practice address
- 4845 Chubbuck Ave
Chubbuck, ID 83202 - Phone
- (208) 237-3900
- Fax
- (208) 237-4955
- NPI assigned
- Sep 22, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P4731 | ID | Primary |
Addresses
Primary practice location
4845 Chubbuck Ave
Chubbuck, ID 83202
Mailing address
4845 Chubbuck Ave
Chubbuck, ID 83202
Phone (208) 237-3900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P4731 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316649600000",
"number": "1114200599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4845 CHUBBUCK AVE",
"city": "CHUBBUCK",
"state": "ID",
"postal_code": "83202",
"telephone_number": "208-237-3900",
"fax_number": "208-237-4955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4845 CHUBBUCK AVE",
"city": "CHUBBUCK",
"state": "ID",
"postal_code": "83202",
"telephone_number": "208-237-3900",
"fax_number": "208-237-4955"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSEN",
"first_name": "CLINT",
"middle_name": "L",
"credential": "PHARM.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-09-22",
"last_updated": "2011-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P4731",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chubbuck, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.