Provider Demographics
NPI:1518271428
Name:PARDUE, KERRY (CRPH)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:PARDUE
Suffix:
Gender:F
Credentials:CRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WILMOT RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4620
Mailing Address - Country:US
Mailing Address - Phone:847-914-2500
Mailing Address - Fax:847-914-2804
Practice Address - Street 1:3411 CUSTER PKWY
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-1012
Practice Address - Country:US
Practice Address - Phone:972-470-1372
Practice Address - Fax:972-470-1377
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist