Provider Demographics
NPI:1578848537
Name:KERBY, ANDREW BEAU (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BEAU
Last Name:KERBY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-3106
Mailing Address - Country:US
Mailing Address - Phone:530-251-3361
Mailing Address - Fax:
Practice Address - Street 1:2875 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4739
Practice Address - Country:US
Practice Address - Phone:530-257-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist