Provider Demographics
NPI:1093002495
Name:COMPTON, KERRY FREDERICH (RPH)
Entity Type:Individual
Prefix:MR
First Name:KERRY
Middle Name:FREDERICH
Last Name:COMPTON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17277 RIVERSIDE LN
Mailing Address - Street 2:
Mailing Address - City:TICKFAW
Mailing Address - State:LA
Mailing Address - Zip Code:70466
Mailing Address - Country:US
Mailing Address - Phone:985-345-0950
Mailing Address - Fax:504-888-6846
Practice Address - Street 1:5208 VETERANS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006
Practice Address - Country:US
Practice Address - Phone:504-456-7808
Practice Address - Fax:504-888-6846
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.014988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist