Provider Demographics
NPI:1477630895
Name:KEYES PHARMACY LLC
Entity Type:Organization
Organization Name:KEYES PHARMACY LLC
Other - Org Name:KEYES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER - SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALTON
Authorized Official - Last Name:LAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:806-537-3034
Mailing Address - Street 1:201 MAIN STREET BOX 1654
Mailing Address - Street 2:
Mailing Address - City:PANHANDLE
Mailing Address - State:TX
Mailing Address - Zip Code:79068
Mailing Address - Country:US
Mailing Address - Phone:806-537-3034
Mailing Address - Fax:806-537-5461
Practice Address - Street 1:928 N HOBART ST
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-5204
Practice Address - Country:US
Practice Address - Phone:806-669-1202
Practice Address - Fax:806-669-0957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150218Medicaid