Healthcare Provider Details

I. General information

NPI: 1487741245
Provider Name (Legal Business Name): KEYSTONE DRUG LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 MAIN ST
DEER LODGE MT
59722-1058
US

IV. Provider business mailing address

407 MAIN ST
DEER LODGE MT
59722-1058
US

V. Phone/Fax

Practice location:
  • Phone: 406-846-2120
  • Fax: 406-846-2348
Mailing address:
  • Phone: 406-846-2120
  • Fax: 406-846-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number776
License Number StateMT

VIII. Authorized Official

Name: MR. JACK M ANDERSEN
Title or Position: OWNER/ PHARMACIST
Credential: R.PH.
Phone: 406-846-2120