Provider Demographics
NPI:1659615029
Name:EDMONDS, KERRI DIANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:DIANE
Last Name:EDMONDS
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 1:1750 HIGHWAY 160 W
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8009
Mailing Address - Country:US
Mailing Address - Phone:803-396-0450
Mailing Address - Fax:803-396-0452
Practice Address - Street 1:1750 HIGHWAY 160 W
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8009
Practice Address - Country:US
Practice Address - Phone:803-396-0450
Practice Address - Fax:803-396-0452
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-24
Last Update Date:2012-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist