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General NPI Number Information
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NPI Number | 1174395487
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Entity Type | Individual
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Provider Name | JERILYN MCKEON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 1440 SEABISCUIT DR
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City | KAYSVILLE
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State | UT
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Zip | 84037-0175
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Country | US
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Telephone | 435-840-8350
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 SEABISCUIT DR
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City | KAYSVILLE
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State | UT
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Zip | 84037-0175
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Country | US
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Telephone | 435-840-8350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | PH00070051
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | P10671
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 6422274-1701
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License Number State | UT
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