MEDICARE: KEYSTONE PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy
3	3336C0004X	Compounding Pharmacy	5301007431	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2045985	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316049745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE PHARMACY INC

Provider Business Mailing Address
First Line	:	4021 CASCADE RD SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2177
Country	:	US
Telephone Number	:	616-974-9792
Fax Number	:	616-464-3469

Provider Business Practice Location Address
First Line	:	4021 CASCADE RD SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2177
Country	:	US
Telephone Number	:	616-974-9792
Fax Number	:	616-464-3469

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID MILLER
Credential	:	R.PH., PH.D.
Telephone Number	:	616-974-9792

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	03/17/2017

Similar Medicare Providers

1407859457 — MR. THOMAS A. MAGNIFICO RPH
Practice Location Address:

4021 CASCADE RD SE , SUITE 50
GRAND RAPIDS, MI
49546-2177

Practice Phone: 616-974-9792
Practice Fax: 616-464-3469

1003031493 — MRS. SUZANNE NASH ANTHONY R.PH.
Practice Location Address:

4021 CASCADE RD SE
GRAND RAPIDS, MI
49546-2177

Practice Phone: 616-974-9792
Practice Fax:

1891221545 — LOGAN MORSE
Practice Location Address:

4021 CASCADE RD SE STE 50
GRAND RAPIDS, MI
49546-2177

Practice Phone: 517-526-0483
Practice Fax:

1619658713 — OPTIMED HEALTHCARE PARTNERS, PLLC
Practice Location Address:

4021 CASCADE RD SE STE 60
GRAND RAPIDS, MI
49546-2177

Practice Phone: 269-250-8000
Practice Fax: 269-250-8020

1003633447 — RAUL ALBERTO VAZQUEZ MESTRE LCSW
Practice Location Address:

2177 REDCLIFF CIR
GRAND JUNCTION, CO
81507-4520

Practice Phone: 787-648-6027
Practice Fax:

1396682670 — SONYA DAMASO
Practice Location Address:

4218 BURTON ST SE
GRAND RAPIDS, MI
49546-6121

Practice Phone: 616-301-8000
Practice Fax:

Directions to “KEYSTONE PHARMACY INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.