Provider Demographics
NPI:1285175851
Name:KEYSTONE SAMS LLC
Entity type:Organization
Organization Name:KEYSTONE SAMS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND PRINCIPAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARKUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MENZLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-663-8336
Mailing Address - Street 1:203 NORTH BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446
Mailing Address - Country:US
Mailing Address - Phone:215-647-9308
Mailing Address - Fax:215-361-2000
Practice Address - Street 1:203 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2409
Practice Address - Country:US
Practice Address - Phone:215-647-9308
Practice Address - Fax:215-361-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4827063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168342OtherPK