Provider Demographics
NPI:1235733478
Name:DURR, KERRY DEAN
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:DEAN
Last Name:DURR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-0933
Mailing Address - Country:US
Mailing Address - Phone:601-410-4466
Mailing Address - Fax:601-735-5202
Practice Address - Street 1:1621 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-2123
Practice Address - Country:US
Practice Address - Phone:601-649-4670
Practice Address - Fax:601-735-5202
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-06618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist