Provider Demographics
NPI:1629479233
Name:BIVENS, EMILY MCGOWAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MCGOWAN
Last Name:BIVENS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:MCGOWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:929 NEW HIGHWAY 68
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-2726
Mailing Address - Country:US
Mailing Address - Phone:423-351-1277
Mailing Address - Fax:
Practice Address - Street 1:929 NEW HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-2726
Practice Address - Country:US
Practice Address - Phone:423-351-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38595Medicaid