Provider Demographics
NPI:1710419908
Name:CHRISTENSEN, KEESHIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEESHIA
Middle Name:
Last Name:CHRISTENSEN
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 1:486 E NEWPORT PARC LN
Mailing Address - Street 2:#D306
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-6361
Mailing Address - Country:US
Mailing Address - Phone:801-703-8760
Mailing Address - Fax:
Practice Address - Street 1:3723 W 12600 S
Practice Address - Street 2:SUITE 170
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7295
Practice Address - Country:US
Practice Address - Phone:801-285-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7458279-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist