MEDICARE: KERR DRUG INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	6852	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3434177	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326120122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERR DRUG INC

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

Provider Business Practice Location Address
First Line	:	1316 JOHN SMALL AVE
Second Line	:
City	:	WASHINGTON
State	:	NC
Zip	:	27889-3843
Country	:	US
Telephone Number	:	252-946-1818
Fax Number	:	252-975-5785

Authorized Official
Title or Position	:	VP OF PHARMACY
Name	:	MARK GREGORY
Credential	:	RPH
Telephone Number	:	919-544-3896

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	01/04/2012

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Directions to “KERR DRUG INC ” Practice Location

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