Provider Demographics
NPI:1487900841
Name:KERSKY, STUART (RPH)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:KERSKY
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 1:705 BRUTON PL N
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4663
Mailing Address - Country:US
Mailing Address - Phone:336-409-4525
Mailing Address - Fax:
Practice Address - Street 1:WAKE FOREST BAPTIST HEALTH 1 MEDICAL CE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1107
Practice Address - Country:US
Practice Address - Phone:336-716-7522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS022117183500000X
PARP031805L183500000X
NC21684183500000X
IL051.039492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist