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NPI Code Detail

MEDICARE: CHARLES DAVID KERR RPH

MEDICARE: CHARLES DAVID KERR RPH
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
1183500000XPharmacist043743MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12003031778OTHERMOPHARMACY PERMIT
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740596840
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES DAVID KERR RPH
Provider Business Mailing Address
First Line : 2586 W CYNTHIA ST
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65810-1311
Country : US
Telephone Number : 417-343-0635
Fax Number :
Provider Business Practice Location Address
First Line : 2650 W KEARNEY ST
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65803-2037
Country : US
Telephone Number : 417-865-1547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2010
Last Update Date : 08/26/2010

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