S & R Keystone Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

P02060 Issued in MD

Legal business name

S & R KEYSTONE PHARMACY LLC

Doing business as

Keystone Pharmacy
Keystone Pharmacy Inc

Practice address

1358 W North Ave
Baltimore, MD 21217-3536

Phone

(410) 669-1900

Fax

(410) 728-3375

NPI assigned

Oct 7, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Syam K Potluri

Title

Managing Member

Phone

(443) 823-3350

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 2

• KEYSTONE PHARMACY Doing business as
• KEYSTONE PHARMACY INC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641427200000",
    "number": "1063509255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1358 W NORTH AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212173536",
            "telephone_number": "410-669-1900",
            "fax_number": "410-728-3375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1358 W NORTH AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212173536",
            "telephone_number": "410-669-1900",
            "fax_number": "410-728-3375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "S & R KEYSTONE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-07",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A",
        "authorized_official_last_name": "POTLURI",
        "authorized_official_first_name": "SYAM",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "443-823-3350",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MD",
            "license": "P02060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "392202200",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2113811",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KEYSTONE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KEYSTONE PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Community/Retail Pharmacy in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.