=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053989764
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK M KEY PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2021
-----------------------------------------------------
Last Update Date | 06/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 BEE ST
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29401-5703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-577-5011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 FOLLY ROAD BLVD UNIT 446
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29407-8321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1300X
-----------------------------------------------------
Taxonomy Name | Psychiatric Pharmacist
-----------------------------------------------------
License Number | 42139
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------