Provider Demographics
NPI:1831423326
Name:KRT ENTERPRISES
Entity type:Organization
Organization Name:KRT ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KERMIT
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:843-248-4609
Mailing Address - Street 1:1401 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3568
Mailing Address - Country:US
Mailing Address - Phone:843-248-4609
Mailing Address - Fax:843-488-0770
Practice Address - Street 1:1401 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3568
Practice Address - Country:US
Practice Address - Phone:843-248-4609
Practice Address - Fax:843-488-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty