Provider Demographics
NPI:1083007041
Name:KEANE, SHAUNA M (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:M
Last Name:KEANE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 WYNNTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2184
Mailing Address - Country:US
Mailing Address - Phone:508-633-9682
Mailing Address - Fax:
Practice Address - Street 1:2510 WYNNTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2184
Practice Address - Country:US
Practice Address - Phone:706-327-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20698183500000X
GARPH031165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist