=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013069756
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KESHAV RX LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 89 S MAIN ST
-----------------------------------------------------
City | MOUNTAIN TOP
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18707-1920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-474-6520
-----------------------------------------------------
Fax | 570-474-0806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 89 S MAIN ST
-----------------------------------------------------
City | MOUNTAIN TOP
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18707-1920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-474-6520
-----------------------------------------------------
Fax | 570-474-0806
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SANDIP PATEL
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 201-920-9145
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PP412728L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------