Provider Demographics
NPI:1821471053
Name:KEY HEALTH PHARMACY LLC
Entity Type:Organization
Organization Name:KEY HEALTH PHARMACY LLC
Other - Org Name:KEY HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:623-308-1818
Mailing Address - Street 1:560 N ESTRELLA PKWY
Mailing Address - Street 2:SUITE B9
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9315
Mailing Address - Country:US
Mailing Address - Phone:623-271-8577
Mailing Address - Fax:623-322-8558
Practice Address - Street 1:560 N ESTRELLA PKWY
Practice Address - Street 2:SUITE B9
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9315
Practice Address - Country:US
Practice Address - Phone:623-271-8577
Practice Address - Fax:623-322-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZY0064093336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152155OtherPK