Provider Demographics
NPI:1174681522
Name:KEYES DRUG INC
Entity Type:Organization
Organization Name:KEYES DRUG INC
Other - Org Name:KEYES DRUG INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SAAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DINNO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:978-369-3100
Mailing Address - Street 1:2090 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-1911
Mailing Address - Country:US
Mailing Address - Phone:617-244-2794
Mailing Address - Fax:617-332-8094
Practice Address - Street 1:2090 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-1911
Practice Address - Country:US
Practice Address - Phone:617-244-2794
Practice Address - Fax:617-332-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
MA21253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0439738Medicaid
2231556OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0782790001Medicare NSC