Healthcare Provider Details

I. General information

NPI: 1982723979
Provider Name (Legal Business Name): KEITH L HERSEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 W NC HIGHWAY 54
DURHAM NC
27707-5505
US

IV. Provider business mailing address

2 HIGHGROVE LN
DURHAM NC
27713-1968
US

V. Phone/Fax

Practice location:
  • Phone: 919-489-5814
  • Fax:
Mailing address:
  • Phone: 919-572-0698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17392
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: