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General NPI Number Information
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NPI Number | 1093206062
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Entity Type | Organization
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Legal Business Name | KEYSTONE RX CORPORATION INC
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 223 BOX BUTTE AVE
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City | ALLIANCE
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State | NE
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Zip | 69301-3741
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Country | US
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Telephone | 308-762-4811
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Fax | 308-487-3409
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Provider Business Mailing Address
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Address Line | PO BOX 95
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City | HEMINGFORD
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State | NE
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Zip | 69348-0095
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Country | US
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Telephone | 308-762-4811
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | DAVID RANDOLPH
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Credential |
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Telephone | 308-760-1966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 718
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License Number State | NE
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