Provider Demographics
NPI:1114037801
Name:KERR DRUG INC A DELAWARE COMPANY
Entity Type:Organization
Organization Name:KERR DRUG INC A DELAWARE COMPANY
Other - Org Name:KERR DRUG 306
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:336-855-3919
Mailing Address - Street 1:3205 S HOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-6805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3205 S HOLDEN RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-6805
Practice Address - Country:US
Practice Address - Phone:336-855-3919
Practice Address - Fax:336-294-1370
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
NC6860333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3433341OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NC0417699Medicaid
3433341OtherOTHER ID NUMBER-COMMERCIAL NUMBER