NPIMap

Organization Active NPI

Keystone Pharmacy, Inc.

  • Long Term Care Pharmacy
  • Grand Rapids, MI
National Provider Identifier
1245942572
Registry record updated Jan 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
KEYSTONE PHARMACY, INC.
Practice address
4021 Cascade Rd SE
Suite 50
Grand Rapids, MI 49546
Phone
(616) 974-9792
Fax
(616) 464-3469
NPI assigned
Dec 19, 2022
Last updated
Jan 12, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
KEYSTONE PHARMACY, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 12, 2023

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

Authorized official

Name
David Miller, RPHNPI 1245712116
Title
Owner
Phone
(616) 974-9792

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

4021 Cascade Rd SE
Suite 50
Grand Rapids, MI 49546

Mailing address

4021 Cascade Rd SE
Suite 50
Grand Rapids, MI 49546
Phone (616) 974-9792

National Provider Directory

National Provider Directory
Tax ID family
Keystone Pharmacy Inc2 organizations share this tax ID, including this one
Part of
Keystone Pharmacy Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4021 Cascade Rd SE
Ste 50
Grand Rapids, MI 49546
Phone (616) 974-9792

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1671408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673481600000",
    "number": "1245942572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4021 CASCADE RD SE",
            "address_2": "SUITE 50",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-974-9792",
            "fax_number": "616-464-3469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4021 CASCADE RD SE",
            "address_2": "SUITE 50",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-974-9792",
            "fax_number": "616-464-3469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE PHARMACY, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KEYSTONE PHARMACY, INC.",
        "enumeration_date": "2022-12-19",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-974-9792",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; 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.