=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043320732
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KERR DRUG INC A DELAWARE COMPANY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1858 REMOUNT RD
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29406-3270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-747-5213
-----------------------------------------------------
Fax | 843-747-9503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1858 REMOUNT RD
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29406-3270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST MANAGER
-----------------------------------------------------
Name | JEN TRUCKSIS
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 843-747-5213
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 3950
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------