Provider Demographics
NPI:1770784985
Name:KERR HEALTH CARE SERVICES LLC
Entity type:Organization
Organization Name:KERR HEALTH CARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:COPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-544-3896
Mailing Address - Street 1:8431 GARVEY DR
Mailing Address - Street 2:STE 121
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-3267
Mailing Address - Country:US
Mailing Address - Phone:919-534-1352
Mailing Address - Fax:919-534-1450
Practice Address - Street 1:8431 GARVEY DR
Practice Address - Street 2:STE 121
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-3267
Practice Address - Country:US
Practice Address - Phone:919-534-1352
Practice Address - Fax:919-534-1450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
NC081753336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3440384OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NC0920424Medicaid
3440384OtherNCPDP PROVIDER IDENTIFICATION NUMBER