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	6976	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3434343	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1629188321
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	:	6140 FALLS OF NEUSE RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-3528
Country	:	US
Telephone Number	:	919-876-7283
Fax Number	:	919-857-0974

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	01/17/2012

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Directions to “KERR DRUG INC ” Practice Location

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