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General NPI Number Information
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NPI Number | 1588917538
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Entity Type | Organization
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Legal Business Name | KEYSTONE PHARMACY
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 204 S 13TH ST
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City | HARRISBURG
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State | PA
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Zip | 17104-3377
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Country | US
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Telephone | 717-260-9620
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Fax | 717-260-9621
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Provider Business Mailing Address
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Address Line | 204 S 13TH ST
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City | HARRISBURG
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State | PA
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Zip | 17104-3377
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Country | US
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Telephone | 717-260-9620
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Fax | 717-260-9621
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMMED SALEM SALEM
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Credential |
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Telephone | 717-260-9620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP482310
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License Number State | PA
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