# KEYSTONE PHARMACY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KEYSTONE PHARMACY, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1245942572
- **Legal business name:** KEYSTONE PHARMACY, INC.
- **Authorized official:** DAVID MILLER RPH (OWNER)
- **Authorized official phone:** (616) 974-9792

## Contact information

- **Practice address:** 4021 CASCADE RD SE, SUITE 50, GRAND RAPIDS, MI 49546
- **Practice address phone:** (616) 974-9792
- **Practice address fax:** (616) 464-3469
- **Mailing address:** 4021 CASCADE RD SE, SUITE 50, GRAND RAPIDS, MI 49546
- **Mailing address phone:** (616) 974-9792
- **Mailing address fax:** (616) 464-3469

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 12/19/2022
- **Last updated:** 01/12/2023