Provider Demographics
NPI:1366114498
Name:KERBY, CAROL RENEA (PHARMD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:RENEA
Last Name:KERBY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-2920
Mailing Address - Country:US
Mailing Address - Phone:501-302-6010
Mailing Address - Fax:501-206-0335
Practice Address - Street 1:600 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-2920
Practice Address - Country:US
Practice Address - Phone:501-302-6010
Practice Address - Fax:501-206-0335
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08624333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy