Healthcare Provider Details

I. General information

NPI: 1700170354
Provider Name (Legal Business Name): KERRI LEIGH DEFOND PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRI LEIGH MACWHORTER PHARMD

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 WILLETT AVE
RIVERSIDE RI
02915-2067
US

IV. Provider business mailing address

1 APPLE ORCHARD RD
MOORESTOWN NJ
08057-3843
US

V. Phone/Fax

Practice location:
  • Phone: 401-433-5710
  • Fax: 401-433-5713
Mailing address:
  • Phone: 609-923-7314
  • Fax: 856-222-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH04766
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: