Healthcare Provider Details

I. General information

NPI: 1043153893
Provider Name (Legal Business Name): KEYSTONE PHARMACY NEW YORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 JORDAN RD STE 2
TROY NY
12180-8358
US

IV. Provider business mailing address

350 JORDAN RD STE 2
TROY NY
12180-8358
US

V. Phone/Fax

Practice location:
  • Phone: 601-707-9727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAUREN CANTRELL
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 601-707-9727