Healthcare Provider Details

I. General information

NPI: 1902710163
Provider Name (Legal Business Name): KEENAN JORDAN MCDONALD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 SALEM RD
COVINGTON GA
30016-4533
US

IV. Provider business mailing address

2600 HOLCOMB BRIDGE RD APT 1123
ALPHARETTA GA
30022-5387
US

V. Phone/Fax

Practice location:
  • Phone: 678-212-3202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number036544
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: