Healthcare Provider Details

I. General information

NPI: 1336471762
Provider Name (Legal Business Name): DERRICK KEVIN PIERCE PHARM D, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 SARANAC AVE
LAKE PLACID NY
12946-1139
US

IV. Provider business mailing address

PO BOX 4
WILLSBORO NY
12996-0004
US

V. Phone/Fax

Practice location:
  • Phone: 518-523-2011
  • Fax: 518-523-1933
Mailing address:
  • Phone: 518-963-4082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number053700
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: