Provider Demographics
NPI:1295372118
Name:KEYSTONE SPECIALTY CARE PHARMACY
Entity Type:Organization
Organization Name:KEYSTONE SPECIALTY CARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HALA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZZI-LANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:313-805-2444
Mailing Address - Street 1:46325 W 12 MILE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2458
Mailing Address - Country:US
Mailing Address - Phone:248-267-3004
Mailing Address - Fax:248-267-3005
Practice Address - Street 1:46325 W 12 MILE RD STE 150
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2458
Practice Address - Country:US
Practice Address - Phone:313-805-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy