Provider Demographics
NPI:1992064588
Name:CHRISTENSEN, JEFFREY PAUL (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:PAUL
Last Name:CHRISTENSEN
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 1:13451 SE 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1475
Mailing Address - Country:US
Mailing Address - Phone:425-562-1377
Mailing Address - Fax:
Practice Address - Street 1:13451 SE 36TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1475
Practice Address - Country:US
Practice Address - Phone:425-562-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00019714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist