Provider Demographics
NPI:1528800208
Name:BIVENS, ELMONETTE JO (RPH)
Entity type:Individual
Prefix:MS
First Name:ELMONETTE
Middle Name:JO
Last Name:BIVENS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1213
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-1213
Mailing Address - Country:US
Mailing Address - Phone:940-937-9030
Mailing Address - Fax:940-937-9010
Practice Address - Street 1:805 US HIGHWAY 83 N
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-2318
Practice Address - Country:US
Practice Address - Phone:940-937-9030
Practice Address - Fax:940-937-9010
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19724183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist