Healthcare Provider Details

I. General information

NPI: 1063522761
Provider Name (Legal Business Name): KERR DRUG INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 US HIGHWAY 13 BYP
WINDSOR NC
27983-7118
US

IV. Provider business mailing address

3220 SPRING FOREST RD
RALEIGH NC
27616-2822
US

V. Phone/Fax

Practice location:
  • Phone: 252-794-9222
  • Fax: 252-794-3655
Mailing address:
  • Phone: 919-544-3896
  • Fax: 919-544-7719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6855
License Number StateNC

VIII. Authorized Official

Name: MARK GREGORY
Title or Position: VP OF PHARMACY
Credential: RPH
Phone: 919-544-3896