Organization
KEYSTONE PHARMACY INC
Active
Other names
KEYSTONE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID MILLER R.PH., PH.D. (OWNER)
(616) 974-9792
Entity
Organization
Contact information
Practice address
4021 CASCADE RD SE, GRAND RAPIDS, MI 49546-2177
(616) 974-9792
(616) 464-3469
Mailing address
4021 CASCADE RD SE, GRAND RAPIDS, MI 49546-2177
(616) 974-9792
(616) 464-3469
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
5301007431
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2045985
PK
—
05
—
2369086
—
MI
Enumeration date
09/05/2006
Last updated
03/17/2017
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