1326320573 NPI number — KEYSTONE PHARMACY MANAGEMENT LLC

Table of content: (NPI 1326320573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326320573 NPI number — KEYSTONE PHARMACY MANAGEMENT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEYSTONE PHARMACY MANAGEMENT LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326320573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7538 FAIR OAKS PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOERNE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78015-4553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-854-7274
Provider Business Mailing Address Fax Number:
210-490-7716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 CYPRESS CREEK RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
CEDAR PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78613-4528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-258-5533
Provider Business Practice Location Address Fax Number:
512-258-5549
Provider Enumeration Date:
09/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HOHENSEE
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
210-389-6533

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  26049 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5904102 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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