MEDICARE: MINDY DEMETRA KEYS PHARMD, RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	67868	TX

General Provider Information

NPI Number	:	1962003020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDY DEMETRA KEYS PHARMD, RPH

Provider Business Mailing Address
First Line	:	1003 W ELSMERE PL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-5239
Country	:	US
Telephone Number	:	512-947-3103
Fax Number	:

Provider Business Practice Location Address
First Line	:	10858 WURZBACH RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-2434
Country	:	US
Telephone Number	:	210-424-3644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2020
Last Update Date	:	11/05/2020

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