MEDICARE: KERR DRUG INC A DELAWARE COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	3936	SC
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4220808	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1316057003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERR DRUG INC A DELAWARE COMPANY

Provider Business Mailing Address
First Line	:	4411 DURANT AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-5300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4411 DURANT AVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-5300
Country	:	US
Telephone Number	:	843-747-9661
Fax Number	:	843-744-4385

Authorized Official
Title or Position	:	PHARMACIST MANAGER
Name	:	LAURA HYATT
Credential	:	RPH
Telephone Number	:	843-747-9661

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/11/2025

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