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General NPI Number Information
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NPI Number | 1487741245
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Entity Type | Organization
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Legal Business Name | KEYSTONE DRUG LLP
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 407 MAIN ST
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City | DEER LODGE
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State | MT
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Zip | 59722-1058
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Country | US
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Telephone | 406-846-2120
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Fax | 406-846-2348
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Provider Business Mailing Address
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Address Line | 407 MAIN ST
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City | DEER LODGE
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State | MT
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Zip | 59722-1058
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Country | US
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Telephone | 406-846-2120
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Fax | 406-846-2348
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Authorized Official
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Title or Position | OWNER/ PHARMACIST
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Name | MR. JACK M ANDERSEN
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Credential | R.PH.
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Telephone | 406-846-2120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 776
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License Number State | MT
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