Provider Demographics
NPI:1124038880
Name:JORGENSEN, STEWART (RPH)
Entity type:Individual
Prefix:MR
First Name:STEWART
Middle Name:
Last Name:JORGENSEN
Suffix:
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 1:1025 HOSPITAL ROAD
Mailing Address - Street 2:P O DRAWER A
Mailing Address - City:SCHURZ
Mailing Address - State:NV
Mailing Address - Zip Code:89427-0500
Mailing Address - Country:US
Mailing Address - Phone:775-773-2345
Mailing Address - Fax:775-773-2395
Practice Address - Street 1:1025 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:SCHURZ
Practice Address - State:NV
Practice Address - Zip Code:89427-0500
Practice Address - Country:US
Practice Address - Phone:775-773-2345
Practice Address - Fax:775-773-2395
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV08244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist