Provider Demographics
NPI:1699176065
Name:KERREG LLC
Entity Type:Organization
Organization Name:KERREG LLC
Other - Org Name:DELIVERX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-397-6905
Mailing Address - Street 1:2453 S BRAESWOOD BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4305
Mailing Address - Country:US
Mailing Address - Phone:713-397-6905
Mailing Address - Fax:
Practice Address - Street 1:241 E CROSSTIMBERS ST UNIT C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-4417
Practice Address - Country:US
Practice Address - Phone:832-767-2122
Practice Address - Fax:832-740-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
TX298523336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151112OtherPK
423566Medicare PIN