Provider Demographics
NPI:1598084618
Name:KEAHEY, WANDA J (PHARMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:J
Last Name:KEAHEY
Suffix:
Gender:F
Credentials:PHARMD, MPH
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 4973
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39296-4973
Mailing Address - Country:US
Mailing Address - Phone:601-668-8525
Mailing Address - Fax:
Practice Address - Street 1:3029 LILLY ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-7246
Practice Address - Country:US
Practice Address - Phone:601-668-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS084171835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist