Provider Demographics
NPI:1558862086
Name:KEYONA LLC
Entity Type:Organization
Organization Name:KEYONA LLC
Other - Org Name:PALMS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MD
Authorized Official - Middle Name:KHORSHED
Authorized Official - Last Name:ANWAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-455-3483
Mailing Address - Street 1:7790 LAKE UNDERHILL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8216
Mailing Address - Country:US
Mailing Address - Phone:407-723-0200
Mailing Address - Fax:407-723-0100
Practice Address - Street 1:7790 LAKE UNDERHILL RD STE 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8216
Practice Address - Country:US
Practice Address - Phone:407-723-0200
Practice Address - Fax:407-723-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH311843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175671OtherPK