Healthcare Provider Details

I. General information

NPI: 1184231920
Provider Name (Legal Business Name): KEYSTONE RX CORPORATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 NIOBRARA AVE
HEMINGFORD NE
69348-9703
US

IV. Provider business mailing address

PO BOX 95
HEMINGFORD NE
69348-0095
US

V. Phone/Fax

Practice location:
  • Phone: 308-487-5212
  • Fax: 308-487-5235
Mailing address:
  • Phone: 308-487-5212
  • Fax: 308-487-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BLANCHE ANNE RANDOLPH
Title or Position: OWNER/MANAGER
Credential:
Phone: 308-487-5212