Keonjala Shanae Williams, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

PS56665 Issued in FL

Practice address

100 2ND Ave SE
Jasper, FL 32052-6114

Phone

(386) 792-2551

Fax

(386) 792-3577

NPI assigned

Nov 30, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Holiday CVS L.L.C.

  • Pharmacy
  • Wesley Chapel, FL
  • NPI 1770467466
  NPD (past)
• Holiday CVS LLC

  • Pharmacy
  • Jasper, FL
  • NPI 1114021078
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1760087738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 2ND AVE SE",
            "city": "JASPER",
            "state": "FL",
            "postal_code": "320526114",
            "telephone_number": "386-792-2551",
            "fax_number": "386-792-3577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 2ND AVE SE",
            "city": "JASPER",
            "state": "FL",
            "postal_code": "320526114",
            "telephone_number": "386-792-2551",
            "fax_number": "386-792-3577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "KEONJALA",
        "middle_name": "SHANAE",
        "name_prefix": "Ms.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-30",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS56665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BOARD OF PHARMACY",
            "identifier": "PS56665",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suwannee FL Opco LLC
• Daisy Vickers, R.N.
• Watson Healthcare LLC
• James Edwin Watson Jr., DNP-BC
• Nancy Wiegand, R.N.
• Nicole Wilson

• Pharmacist in Jasper, FL
• Providers in Jasper, FL by specialty
• Pharmacist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.