=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346669033
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEYSTONERX LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2014
-----------------------------------------------------
Last Update Date | 04/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3070 BRISTOL PIKE BLDG. 2 STE. 132
-----------------------------------------------------
City | BENSALEM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19020-5364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-525-8088
-----------------------------------------------------
Fax | 888-525-1525
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3070 BRISTOL PIKE BLDG 2 STE 132
-----------------------------------------------------
City | BENSALEM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19020-5364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-525-8088
-----------------------------------------------------
Fax | 888-525-1525
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER, OWNER
-----------------------------------------------------
Name | ROBERT TRUITT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-525-8088
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------