Provider Demographics
NPI:1063057594
Name:KEENE, CATHERINE OLIVIA (PHARMD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:OLIVIA
Last Name:KEENE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:OLIVIA
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26815 NW 98TH ST
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-3359
Mailing Address - Country:US
Mailing Address - Phone:352-339-1648
Mailing Address - Fax:
Practice Address - Street 1:24220 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-2211
Practice Address - Country:US
Practice Address - Phone:352-472-9001
Practice Address - Fax:352-472-8776
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist