Provider Demographics
NPI:1861622102
Name:KERMON, LOUIS TODD JR
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:TODD
Last Name:KERMON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 OLIVE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-6195
Mailing Address - Country:US
Mailing Address - Phone:919-552-8728
Mailing Address - Fax:919-552-7145
Practice Address - Street 1:121 OLIVE BRANCH RD
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-6195
Practice Address - Country:US
Practice Address - Phone:919-552-8728
Practice Address - Fax:919-552-7145
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist