# NEW BERLIN PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** New Berlin Pharmacy Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396982666
- **Authorized official:** JASON KILVINGER (OWNER)
- **Authorized official phone:** (414) 881-2766

## Contact information

- **Practice address:** 14105 W GREENFIELD AVE, NEW BERLIN, WI 53151-1640
- **Practice address phone:** (262) 782-0460
- **Practice address fax:** (262) 782-4124
- **Mailing address:** 14105 W GREENFIELD AVE, NEW BERLIN, WI 53151-1640
- **Mailing address phone:** (262) 782-0460
- **Mailing address fax:** (262) 782-4124

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 8899042 | WI | Yes |

## Other

- **Enumeration date:** 01/08/2009
- **Last updated:** 05/10/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5131343 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |