Healthcare Provider Details

I. General information

NPI: 1477630895
Provider Name (Legal Business Name): KEYES PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 N HOBART ST
PAMPA TX
79065-5204
US

IV. Provider business mailing address

201 MAIN STREET BOX 1654
PANHANDLE TX
79068
US

V. Phone/Fax

Practice location:
  • Phone: 806-669-1202
  • Fax: 806-669-0957
Mailing address:
  • Phone: 806-537-3034
  • Fax: 806-537-5461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK ALTON LAND
Title or Position: OWNER - SOLE MEMBER
Credential: PHARMD
Phone: 806-537-3034