Healthcare Provider Details

I. General information

NPI: 1508497835
Provider Name (Legal Business Name): KESHIA ROSE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 MOUNT PLEASANT RD
CHESAPEAKE VA
23322-4043
US

IV. Provider business mailing address

1401 N MAIN ST
SUFFOLK VA
23434-4352
US

V. Phone/Fax

Practice location:
  • Phone: 757-217-4036
  • Fax:
Mailing address:
  • Phone: 757-539-4834
  • Fax: 757-539-2076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202212994
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: