Provider Demographics
NPI:1528798717
Name:KEYSTONE FAMILY PHARMACY, LLC
Entity type:Organization
Organization Name:KEYSTONE FAMILY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:248-267-3004
Mailing Address - Street 1:46325 W 12 MILE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2458
Mailing Address - Country:US
Mailing Address - Phone:248-267-3004
Mailing Address - Fax:
Practice Address - Street 1:46325 W 12 MILE RD STE 150
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2458
Practice Address - Country:US
Practice Address - Phone:248-267-3004
Practice Address - Fax:248-267-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-12
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy