Provider Demographics
NPI:1598196446
Name:JORGENSON, CHERYL DAWN (PHARMD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:DAWN
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150155
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-0155
Mailing Address - Country:US
Mailing Address - Phone:817-367-4265
Mailing Address - Fax:877-246-3291
Practice Address - Street 1:401 SOUTH JIM WRIGHT FREEWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108
Practice Address - Country:US
Practice Address - Phone:817-367-4265
Practice Address - Fax:877-361-5900
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX468011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist