Healthcare Provider Details

I. General information

NPI: 1861716946
Provider Name (Legal Business Name): KERR DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NC 102 W
AYDEN NC
28513-8792
US

IV. Provider business mailing address

140 NC 102 W
AYDEN NC
28513-8792
US

V. Phone/Fax

Practice location:
  • Phone: 252-746-3026
  • Fax: 252-746-7953
Mailing address:
  • Phone: 252-746-3026
  • Fax: 252-746-7953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number20349
License Number StateNC

VIII. Authorized Official

Name: JOANN BROWN
Title or Position: DISTRICT PHARMACY SUPERVISOR
Credential: PHARM D
Phone: 919-222-3643