Provider Demographics
NPI:1013027705
Name:KERR DRUG INC
Entity Type:Organization
Organization Name:KERR DRUG INC
Other - Org Name:KERR DRUG
Other - Org Type:Doing Business As
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 1:6525 JORDAN ROAD
Practice Address - Street 2:
Practice Address - City:RAMSEUR
Practice Address - State:NC
Practice Address - Zip Code:27316
Practice Address - Country:US
Practice Address - Phone:336-824-1276
Practice Address - Fax:336-824-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC68863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0765502Medicaid
3433543OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1193760055Medicare NSC