Provider Demographics
NPI:1427367218
Name:EASTERLING, KERRY M SR (RPH)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:M
Last Name:EASTERLING
Suffix:SR
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 1:1100 HWY 13 NORTH
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429
Mailing Address - Country:US
Mailing Address - Phone:601-736-3394
Mailing Address - Fax:601-736-3499
Practice Address - Street 1:1100 HWY 13 NORTH
Practice Address - Street 2:FREDS PHARMACY
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429
Practice Address - Country:US
Practice Address - Phone:601-736-3394
Practice Address - Fax:601-736-3499
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-7865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist