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Individual

CHARLES DAVID KERR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
RPH

Contact information

Practice address
2650 W KEARNEY ST, SPRINGFIELD, MO 65803-2037
(417) 865-1547
Mailing address
2586 W CYNTHIA ST, SPRINGFIELD, MO 65810-1311
(417) 343-0635

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
043743
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2003031778
PHARMACY PERMIT
MO
05
606075505
MO
Enumeration date
08/26/2010
Last updated
08/26/2010
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