Provider Demographics
NPI:1275053761
Name:MOUNTAIN KEY RX
Entity Type:Organization
Organization Name:MOUNTAIN KEY RX
Other - Org Name:MOUNTAIN KEY RX
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-810-6408
Mailing Address - Street 1:18172 TELLER COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:CO
Mailing Address - Zip Code:80816
Mailing Address - Country:US
Mailing Address - Phone:719-309-9525
Mailing Address - Fax:719-452-3884
Practice Address - Street 1:18172 TELLER COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:CO
Practice Address - Zip Code:80816
Practice Address - Country:US
Practice Address - Phone:303-810-6408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO168-172OtherPDO#