Provider Demographics
NPI:1962003020
Name:KEYS, MINDY DEMETRA (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:DEMETRA
Last Name:KEYS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 W ELSMERE PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5239
Mailing Address - Country:US
Mailing Address - Phone:512-947-3103
Mailing Address - Fax:
Practice Address - Street 1:10858 WURZBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2434
Practice Address - Country:US
Practice Address - Phone:210-424-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist