Provider Demographics
NPI:1750631172
Name:RIDENER, KEEVIE CHINSETHAGID (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KEEVIE
Middle Name:CHINSETHAGID
Last Name:RIDENER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 S YALE AVE
Mailing Address - Street 2:T0019
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-6221
Mailing Address - Country:US
Mailing Address - Phone:918-293-0196
Mailing Address - Fax:918-877-2520
Practice Address - Street 1:1701 S YALE AVE
Practice Address - Street 2:T0019
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-6221
Practice Address - Country:US
Practice Address - Phone:918-293-0196
Practice Address - Fax:918-877-2520
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist