Provider Demographics
NPI:1427797703
Name:IVENS, RICHMOND KEITH (PHARMD)
Entity type:Individual
Prefix:
First Name:RICHMOND
Middle Name:KEITH
Last Name:IVENS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ADMINISTRATION RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6954
Mailing Address - Country:US
Mailing Address - Phone:865-483-8429
Mailing Address - Fax:
Practice Address - Street 1:106 ADMINISTRATION RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6954
Practice Address - Country:US
Practice Address - Phone:865-483-8429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist