Provider Demographics
NPI:1336422138
Name:BENNETT, KAHIESIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KAHIESIA
Middle Name:
Last Name:BENNETT
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 1:14 BEEKMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1412
Mailing Address - Country:US
Mailing Address - Phone:917-497-0372
Mailing Address - Fax:
Practice Address - Street 1:2290 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1216
Practice Address - Country:US
Practice Address - Phone:914-793-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442842183500000X
NJ28RI03347700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist