MEDICARE: KERREG LLC

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
2	3336S0011X	Specialty Pharmacy
3	3336C0003X	Community/Retail Pharmacy	29852	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2151112	OTHER		PK

General Provider Information

NPI Number	:	1699176065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERREG LLC

Provider Business Mailing Address
First Line	:	2453 S BRAESWOOD BLVD STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4305
Country	:	US
Telephone Number	:	713-397-6905
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 E CROSSTIMBERS ST UNIT C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-4417
Country	:	US
Telephone Number	:	832-767-2122
Fax Number	:	832-740-4375

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	DANIELA ESPINO
Credential	:
Telephone Number	:	713-397-6905

Provider Enumeration Date	:	09/04/2014
Last Update Date	:	12/01/2015

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Directions to “KERREG LLC ” Practice Location

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