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KEYSTONE PHARMACY, INC.
NPI 1245942572
Pharmacy - Long Term Care Pharmacy in Grand Rapids, MI

Active since December 19, 2022CLIA 23D2067081 · Waiver
4021 CASCADE RD SE, SUITE 50, GRAND RAPIDS, MI 49546(616) 974-9792(616) 464-3469 Get Directions Write a Review

NPPES record last updated: January 12, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jan 12, 2023, Dec 19, 2022 (2 updates tracked since 2022).

About Keystone Pharmacy, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KEYSTONE PHARMACY, INC. (NPI 1245942572) is a healthcare organization registered as a long term care pharmacy in Grand Rapids, Michigan and active in the NPI registry since December 2022. The organization holds a CLIA Waiver certificate valid through September 10, 2026 and lists David Miller, Owner, as its authorized official.

NPPES Registry Identity

NPI1245942572
Entity TypeOrganization
Primary Taxonomy3336L0003X
Legal Business NameKEYSTONE PHARMACY, INC.
Location Address4021 CASCADE RD SE, SUITE 50Grand Rapids, MI 49546
Mailing Address4021 Cascade Rd Se, Suite 50Grand Rapids, MI 49546 · (616) 974-9792 · Fax (616) 464-3469
Phone(616) 974-9792
Fax(616) 464-3469
Organization SubpartYes
Authorized OfficialDavid MillerOwner · (616) 974-9792
Enumeration DateDecember 19, 2022
Last NPPES UpdateJanuary 12, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 12, 2023
✔ NPI 1245942572 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Long Term Care PharmacySuppliers
Taxonomy Code3336L0003X
Definition
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.
Also ListedPharmacy · Community/Retail PharmacyTaxonomy 3336C0003X
4021 CASCADE RD SE, Grand Rapids, MI 49546
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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 23D2067081

Keystone Pharmacy · Grand Rapids, MI
Active · expires Sep 10, 2026
CLIA Number23D2067081
Laboratory TypePharmacy
Certificate Effective DateSeptember 11, 2024
Certificate Expiration DateSeptember 10, 2026
Laboratory DirectorDavid J. Miller
Laboratory Phone(616) 974-9792
Laboratory LocationKeystone Pharmacy4021 Cascade Rd SE, Suite 50, Grand Rapids, MI 49546
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. SUZANNE NASH ANTHONY R.PH.
Pharmacist
4021 CASCADE RD SE
GRAND RAPIDS, MI 49546
Kent County (616) 974-9792
DR. DAVID JOSEPH MILLER RPH, PHD
Pharmacist
4021 CASCADE RD SE, SUITE 50
GRAND RAPIDS, MI 49546
Kent County (616) 974-9792
KEYSTONE PHARMACY INC
Pharmacy (Compounding Pharmacy)
4021 CASCADE RD SE
GRAND RAPIDS, MI 49546
Kent County (616) 974-9792
MR. THOMAS A. MAGNIFICO RPH
Pharmacist
4021 CASCADE RD SE, SUITE 50
GRAND RAPIDS, MI 49546
Kent County (616) 974-9792

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Keystone Pharmacy, Inc.'s NPI number?

The NPI number for Keystone Pharmacy, Inc. is 1245942572. It was assigned to this organization in the NPPES registry on December 19, 2022.

Where is Keystone Pharmacy, Inc. located?

Keystone Pharmacy, Inc. is located at 4021 Cascade Rd SE Suite 50, Grand Rapids, MI 49546. The listed phone number is (616) 974-9792.

What is Keystone Pharmacy, Inc.'s specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Long Term Care Pharmacy, with taxonomy code 3336L0003X.

Does Keystone Pharmacy, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 23D2067081) is associated with this NPI, valid through September 10, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Keystone Pharmacy, Inc. was last updated on January 12, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.