1720198427 NPI number — KERR DRUG INC

Table of content: (NPI 1720198427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720198427 NPI number — KERR DRUG INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERR DRUG INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KERR DRUG
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720198427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3220 SPRING FOREST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27616-2822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-544-3896
Provider Business Mailing Address Fax Number:
919-544-7719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 N BROWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHADBOURN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28431-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-654-5572
Provider Business Practice Location Address Fax Number:
910-654-5599
Provider Enumeration Date:
08/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GREGORY
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF PHARMACY
Authorized Official Telephone Number:
919-544-3896

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 6532 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0245761 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3433985 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".