Provider Demographics
NPI:1528253945
Name:KERR DRUG INC
Entity type:Organization
Organization Name:KERR DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF PHCY ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:GRAY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-544-3896
Mailing Address - Street 1:PO BOX 75678
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-0678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8995 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9116
Practice Address - Country:US
Practice Address - Phone:843-410-0701
Practice Address - Fax:843-410-0714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
SC509611332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4227193OtherNCPDP
SC1193760182Medicare NSC