Provider Demographics
NPI:1396779575
Name:KEYSTONE POINT MEDICAL PHARMACY, INC.
Entity type:Organization
Organization Name:KEYSTONE POINT MEDICAL PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:PRINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHG
Authorized Official - Phone:305-865-3746
Mailing Address - Street 1:1015 KANE CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2105
Mailing Address - Country:US
Mailing Address - Phone:305-865-3746
Mailing Address - Fax:305-865-2618
Practice Address - Street 1:1015 KANE CONCOURSE
Practice Address - Street 2:
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2105
Practice Address - Country:US
Practice Address - Phone:305-865-3746
Practice Address - Fax:305-865-2618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty