Provider Demographics
NPI:1629330592
Name:BIVENS, KESHA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KESHA
Middle Name:
Last Name:BIVENS
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 1:422 STRAFFORD AVE
Mailing Address - Street 2:APT 3A
Mailing Address - City:STRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2517
Mailing Address - Country:US
Mailing Address - Phone:610-733-3032
Mailing Address - Fax:
Practice Address - Street 1:3900 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4551
Practice Address - Country:US
Practice Address - Phone:610-733-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-00041731835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist