Provider Demographics
NPI:1508113143
Name:KEYSTONE PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:KEYSTONE PHARMACY SERVICES LLC
Other - Org Name:UT STUDENT HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:PEYTON
Authorized Official - Middle Name:NOBLE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-974-5932
Mailing Address - Street 1:1800 VOLUNTEER BLVD STE 153
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37996-4713
Mailing Address - Country:US
Mailing Address - Phone:865-974-5933
Mailing Address - Fax:
Practice Address - Street 1:1800 VOLUNTEER BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37996-4522
Practice Address - Country:US
Practice Address - Phone:865-974-3135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy