Provider Demographics
NPI:1104870260
Name:KERR DRUG INC
Entity type:Organization
Organization Name:KERR DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
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 1:816 N MAIN ST
Practice Address - Street 2:DARLINGTON PLZ
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2067
Practice Address - Country:US
Practice Address - Phone:919-552-4248
Practice Address - Fax:919-552-8965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC65063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0929594Medicaid
3433226OtherNCPDP PROVIDER IDENTIFICATION NUMBER
2801153Medicare PIN
1193760118Medicare NSC
3433226OtherNCPDP PROVIDER IDENTIFICATION NUMBER