Provider Demographics
NPI:1538755806
Name:KEYSTONE PHARMACY
Entity type:Organization
Organization Name:KEYSTONE PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SURINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:PAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-863-8113
Mailing Address - Street 1:11242 FM 1960 RD W STE 106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3635
Mailing Address - Country:US
Mailing Address - Phone:832-478-5198
Mailing Address - Fax:832-604-6575
Practice Address - Street 1:11242 FM 1960 RD W STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3635
Practice Address - Country:US
Practice Address - Phone:832-863-8113
Practice Address - Fax:832-604-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33570OtherTEXAS STATE BOARD OF PHARMACY