MEDICARE: KEYSTONE POINT MEDICAL 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	183500000X	Pharmacist	11502	FL

General Provider Information

NPI Number	:	1396779575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE POINT MEDICAL PHARMACY, INC.

Provider Business Mailing Address
First Line	:	1015 KANE CONCOURSE
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2105
Country	:	US
Telephone Number	:	305-865-3746
Fax Number	:	305-865-2618

Provider Business Practice Location Address
First Line	:	1015 KANE CONCOURSE
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2105
Country	:	US
Telephone Number	:	305-865-3746
Fax Number	:	305-865-2618

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MELVIN BERNARD PRINE
Credential	:	PHG
Telephone Number	:	305-865-3746

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/22/2020

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