Healthcare Provider Details

I. General information

NPI: 1700871332
Provider Name (Legal Business Name): KERRI L DEPROFIO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 BILLERICA RD PHARMACY DEPARTMENT
CHELMSFORD MA
01824-3604
US

IV. Provider business mailing address

6 PRIMROSE RD
BILLERICA MA
01821-3026
US

V. Phone/Fax

Practice location:
  • Phone: 978-250-6162
  • Fax: 978-250-6229
Mailing address:
  • Phone: 978-670-8949
  • Fax: 978-250-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24177
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: