Healthcare Provider Details

I. General information

NPI: 1164701645
Provider Name (Legal Business Name): KEYES' COMPOUNDING & SPECIALTY DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 W 3RD ST
ELK CITY OK
73644-5114
US

IV. Provider business mailing address

1602 W 3RD ST
ELK CITY OK
73644-5114
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-5273
  • Fax: 580-303-4483
Mailing address:
  • Phone: 580-225-5273
  • Fax: 580-303-4483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. SUZANNE HUTTON KEYES
Title or Position: PHARMD/OWNER
Credential: PHARMD
Phone: 580-799-1499