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General NPI Number Information
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NPI Number | 1982723979
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Entity Type | Individual
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Provider Name | KEITH L HERSEY PHARMD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1311 W NC HIGHWAY 54
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City | DURHAM
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State | NC
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Zip | 27707-5505
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Country | US
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Telephone | 919-489-5814
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Fax |
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Provider Business Mailing Address
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Address Line | 2 HIGHGROVE LN
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City | DURHAM
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State | NC
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Zip | 27713-1968
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Country | US
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Telephone | 919-572-0698
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Fax |
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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 | 17392
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License Number State | NC
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