Organization
KEYSTONE PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINEETH NADIMPALLY (PRESIDENT)
(602) 767-0606
Entity
Organization
Contact information
Practice address
9133 W THUNDERBIRD RD STE 101, PEORIA, AZ 85381-4269
(602) 767-0606
(602) 767-0568
Mailing address
9133 W THUNDERBIRD RD STE 101, PEORIA, AZ 85381-4269
(602) 767-0606
(602) 767-0568
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y008829
ARIZONA STATE BOARD OF PHARMACY
AZ
Enumeration date
06/21/2021
Last updated
06/21/2021
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