Provider Demographics
NPI:1497344485
Name:KEITH, MEEWON JAMIE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:MEEWON
Middle Name:JAMIE
Last Name:KEITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:500 CATHEDRAL DR UNIT 28
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95001-5002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32980 ALVARADO NILES RD STE 836
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3186
Practice Address - Country:US
Practice Address - Phone:800-552-5520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447741835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist