Healthcare Provider Details

I. General information

NPI: 1740101906
Provider Name (Legal Business Name): KSENYA KAVVA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 W HARRISON ST
CHICAGO IL
60612-3825
US

IV. Provider business mailing address

800 S WELLS ST APT 811
CHICAGO IL
60607-4533
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5000
  • Fax:
Mailing address:
  • Phone: 732-570-2109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License Number051.305151
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: