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General NPI Number Information
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NPI Number | 1235733478
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Entity Type | Individual
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Provider Name | KERRY DEAN DURR
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Gender | Male
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Dates
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Enumeration Date | 11/29/2020
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Last Update Date | 11/29/2020
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Provider Practice Location Address
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Address Line | 1621 HIGHWAY 15 N
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City | LAUREL
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State | MS
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Zip | 39440-2123
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Country | US
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Telephone | 601-649-4670
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Fax | 601-735-5202
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Provider Business Mailing Address
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Address Line | PO BOX 933
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City | WAYNESBORO
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State | MS
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Zip | 39367-0933
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Country | US
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Telephone | 601-410-4466
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Fax | 601-735-5202
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | E-06618
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License Number State | MS
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