Provider Demographics
NPI:1629528526
Name:KEYSTONE PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:KEYSTONE PHARMACY SERVICES LLC
Other - Org Name:THE PHARMACY AT LSU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFURS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-671-7787
Mailing Address - Street 1:10360 DEERBORN LANE
Mailing Address - Street 2:
Mailing Address - City:KNOXILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932
Mailing Address - Country:US
Mailing Address - Phone:865-671-7800
Mailing Address - Fax:865-671-0064
Practice Address - Street 1:STUDENT HEALTH CENTER BUILDING
Practice Address - Street 2:INFIRMARY DR ROOM 172 LOUISIANA STATE UNIVERSITY
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70803-0001
Practice Address - Country:US
Practice Address - Phone:225-578-5651
Practice Address - Fax:225-578-7684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY.007378-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164500OtherPK