Provider Demographics
NPI:1164701645
Name:KEYES' COMPOUNDING & SPECIALTY DRUG
Entity Type:Organization
Organization Name:KEYES' COMPOUNDING & SPECIALTY DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:HUTTON
Authorized Official - Last Name:KEYES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:580-799-1499
Mailing Address - Street 1:1602 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-5114
Mailing Address - Country:US
Mailing Address - Phone:580-225-5273
Mailing Address - Fax:580-303-4483
Practice Address - Street 1:1602 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5114
Practice Address - Country:US
Practice Address - Phone:580-225-5273
Practice Address - Fax:580-303-4483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200473740BMedicaid