Provider Demographics
NPI:1679683361
Name:KERR DRUG INC A DELAWARE COMPANY
Entity Type:Organization
Organization Name:KERR DRUG INC A DELAWARE COMPANY
Other - Org Name:KERR DRUG 417
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCLE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-856-1610
Mailing Address - Street 1:2720 LAKE WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-5861
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2720 LAKE WHEELER RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-5861
Practice Address - Country:US
Practice Address - Phone:919-856-1610
Practice Address - Fax:919-839-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6510333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0929537Medicaid
3433264OtherOTHER ID NUMBER-COMMERCIAL NUMBER
3433264OtherOTHER ID NUMBER-COMMERCIAL NUMBER