Key Compounding Pharmacy

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

2004027988 Issued in MO

Legal business name

KEY COMPOUNDING PHARMACY

Practice address

912 North Westwood Blvd
Poplar Bluff, MO 63901

Phone

(573) 785-8219

Fax

(573) 785-8125

NPI assigned

Apr 13, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Martin H Michel, R.PH., M.B.A., C.D.E

Title

Owner

Phone

(573) 785-8219

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083838452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 NORTH WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "63901",
            "telephone_number": "573-785-8219",
            "fax_number": "573-785-8125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 NORTH WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "63901",
            "telephone_number": "573-785-8219",
            "fax_number": "573-785-8125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEY COMPOUNDING PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MICHEL",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-785-8219",
        "authorized_official_credential": "R.PH., M.B.A., C.D.E"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "MO",
            "license": "2004027988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Keith, APRN-BC
• Carol Marie Kellison
• Simeon Sky Kelly
• John Judson Kersbergen, PHARMACIST
• Raymond Benjamin Ketting, M.D.
• Naureen Khan, MD
• Sehrish Khan, MD
• Sheryar Ali Khan, DO
• Yaqoob Khan, MD
• Lynn T Khanuja, MA, LPC, OTR/L

• Compounding Pharmacy in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Compounding Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.