Provider Demographics
NPI:1073813895
Name:MCKEEVER, SHAUNA M (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:M
Last Name:MCKEEVER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 690026
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95269-0026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2449 W KETTLEMAN LN
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4124
Practice Address - Country:US
Practice Address - Phone:209-367-7744
Practice Address - Fax:209-367-7889
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist