Organization
S & R KEYSTONE PHARMACY LLC
Active
Other names
KEYSTONE PHARMACY, KEYSTONE PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SYAM K POTLURI (MANAGING MEMBER)
(443) 823-3350
Entity
Organization
Contact information
Practice address
1358 W NORTH AVE, BALTIMORE, MD 21217-3536
(410) 669-1900
(410) 728-3375
Mailing address
1358 W NORTH AVE, BALTIMORE, MD 21217-3536
(410) 669-1900
(410) 728-3375
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
P02060
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2113811
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
392202200
—
MD
Enumeration date
10/07/2006
Last updated
01/06/2022
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