Active NPI
Alan Jensen
- Pharmacist
- Idaho Falls, ID
National Provider Identifier
1467749044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P4239
- Practice address
- 590 E 17TH St
Idaho Falls, ID 83404-6154 - Phone
- (208) 523-1090
- Fax
- (208) 528-8681
- NPI assigned
- Jul 5, 2011
- Sex
- Male
- Sole proprietor
- No
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 | P4239 | ID | Primary |
Addresses
Primary practice location
590 E 17TH St
Idaho Falls, ID 83404-6154
Mailing address
590 E 17TH St
Idaho Falls, ID 83404-6154
Phone (208) 523-1090
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P4239 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309824000000",
"number": "1467749044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "590 E 17TH ST",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834046154",
"telephone_number": "208-523-1090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "590 E 17TH ST",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834046154",
"telephone_number": "208-523-1090",
"fax_number": "208-528-8681"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENSEN",
"first_name": "ALAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-05",
"last_updated": "2011-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P4239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 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.