Provider Demographics
NPI:1053591305
Name:KERR DRUG, INC
Entity type:Organization
Organization Name:KERR DRUG, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THIRD PARTY SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:O'MARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-544-3896
Mailing Address - Street 1:3220 SPRING FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2822
Mailing Address - Country:US
Mailing Address - Phone:919-544-3896
Mailing Address - Fax:919-544-7719
Practice Address - Street 1:3220 SPRING FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-2822
Practice Address - Country:US
Practice Address - Phone:919-544-3896
Practice Address - Fax:919-544-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2801153AMedicare PIN