Provider Demographics
NPI:1508094525
Name:ANTOLICK, KERI ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:ANN
Last Name:ANTOLICK
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 1:7820 TYLERTON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1553
Mailing Address - Country:US
Mailing Address - Phone:724-622-5959
Mailing Address - Fax:
Practice Address - Street 1:1910 FALLS VALLEY DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3445
Practice Address - Country:US
Practice Address - Phone:919-844-5440
Practice Address - Fax:919-844-5116
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist