Healthcare Provider Details

I. General information

NPI: 1366819385
Provider Name (Legal Business Name): RACHEL MARIE KERR PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 W EL CAMINO ALTO ST
SPRINGFIELD MO
65810-4719
US

IV. Provider business mailing address

1530 E ERIE ST APTD 306
SPRINGFIELD MO
65804-6439
US

V. Phone/Fax

Practice location:
  • Phone: 417-414-6626
  • Fax:
Mailing address:
  • Phone: 417-300-0764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2013026230
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number021003
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: