Provider Demographics
NPI:1477146363
Name:FINE, KERRY MARIE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:MARIE
Last Name:FINE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MOUNTAIN BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5696
Mailing Address - Country:US
Mailing Address - Phone:908-754-4400
Mailing Address - Fax:908-754-1836
Practice Address - Street 1:62 MOUNTAIN BLVD STE 1
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5696
Practice Address - Country:US
Practice Address - Phone:908-754-4400
Practice Address - Fax:908-754-1836
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03015900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist