Healthcare Provider Details

I. General information

NPI: 1821471053
Provider Name (Legal Business Name): KEY HEALTH PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 N ESTRELLA PKWY SUITE B9
GOODYEAR AZ
85338-9315
US

IV. Provider business mailing address

560 N ESTRELLA PKWY SUITE B9
GOODYEAR AZ
85338-9315
US

V. Phone/Fax

Practice location:
  • Phone: 623-271-8577
  • Fax: 623-322-8558
Mailing address:
  • Phone: 623-271-8577
  • Fax: 623-322-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY006409
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KEY LAM
Title or Position: PHARMACIST/OWNER
Credential: PHARM D
Phone: 623-308-1818