| Organization Name: | KEY COMPOUNDING PHARMACY |
| NPI Number: | 1083838452 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARTIN H MICHEL (OWNER) |
| Mailing Address: | 912 North Westwood Blvd Poplar Bluff |
| State: | MO US |
| Postal Code: | 63901 |
| Phone Number: | 5737858219 |
| Fax Number: | 5737858125 |
| NPI Enumeration Date: | 04/13/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | 2004027988 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |