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General NPI Number Information
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NPI Number | 1831423326
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Entity Type | Organization
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Legal Business Name | KRT ENTERPRISES
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Dates
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Enumeration Date | 09/30/2009
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Last Update Date | 09/30/2009
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Provider Practice Location Address
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Address Line | 1401 MAIN ST
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City | CONWAY
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State | SC
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Zip | 29526-3568
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Country | US
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Telephone | 843-248-4609
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Fax | 843-488-0770
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Provider Business Mailing Address
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Address Line | 1401 MAIN ST
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City | CONWAY
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State | SC
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Zip | 29526-3568
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Country | US
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Telephone | 843-248-4609
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Fax | 843-488-0770
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Authorized Official
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Title or Position | RPH/OWNER
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Name | MR. KERMIT RANDALL TODD
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Credential | RPH
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Telephone | 843-248-4609
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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 |
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License Number State |
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