Provider Demographics
NPI:1043320732
Name:KERR DRUG INC A DELAWARE COMPANY
Entity Type:Organization
Organization Name:KERR DRUG INC A DELAWARE COMPANY
Other - Org Name:KERR DRUG 611
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUCKSIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-747-5213
Mailing Address - Street 1:1858 REMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-3270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1858 REMOUNT RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-3270
Practice Address - Country:US
Practice Address - Phone:843-747-5213
Practice Address - Fax:843-747-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3950333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC739502Medicaid
4220834OtherOTHER ID NUMBER-COMMERCIAL NUMBER
SC739502Medicaid