Provider Demographics
NPI:1013056902
Name:KERBY, JEREL LYNN (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEREL
Middle Name:LYNN
Last Name:KERBY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W SCURRY ST STE C
Mailing Address - Street 2:
Mailing Address - City:DAINGERFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:75638-1661
Mailing Address - Country:US
Mailing Address - Phone:903-645-5933
Mailing Address - Fax:903-645-5934
Practice Address - Street 1:213 W SCURRY ST STE C
Practice Address - Street 2:
Practice Address - City:DAINGERFIELD
Practice Address - State:TX
Practice Address - Zip Code:75638-1661
Practice Address - Country:US
Practice Address - Phone:903-645-5933
Practice Address - Fax:903-645-5934
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist