Healthcare Provider Details

I. General information

NPI: 1235733478
Provider Name (Legal Business Name): KERRY DEAN DURR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2020
Last Update Date: 11/29/2020
Certification Date: 11/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 HIGHWAY 15 N
LAUREL MS
39440-2123
US

IV. Provider business mailing address

PO BOX 933
WAYNESBORO MS
39367-0933
US

V. Phone/Fax

Practice location:
  • Phone: 601-649-4670
  • Fax: 601-735-5202
Mailing address:
  • Phone: 601-410-4466
  • Fax: 601-735-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-06618
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: