Healthcare Provider Details

I. General information

NPI: 1598084618
Provider Name (Legal Business Name): WANDA J KEAHEY PHARMD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3029 LILLY ST
JACKSON MS
39213-7246
US

IV. Provider business mailing address

PO BOX 4973
JACKSON MS
39296-4973
US

V. Phone/Fax

Practice location:
  • Phone: 601-668-8525
  • Fax:
Mailing address:
  • Phone: 601-668-8525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number08417
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: