Provider Demographics
NPI:1063811123
Name:PIERCE, KERRY P (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:P
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:KERRY
Other - Middle Name:K
Other - Last Name:PICKWORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:410 W 10TH AVE RM 368
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1240
Mailing Address - Country:US
Mailing Address - Phone:614-293-8470
Mailing Address - Fax:614-293-3165
Practice Address - Street 1:410 W 10TH AVE RM 368
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-8470
Practice Address - Fax:614-293-3165
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03116921835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist