# BERRY PHARMACY AND WELLNESS SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WEST BEND PHARMACY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871683045
- **Authorized official:** DOUGLAS BERRY RPH (PRESIDENT)
- **Authorized official phone:** (262) 338-6444

## Contact information

- **Practice address:** 1709 S 18TH AVE, WEST BEND, WI 53095-7808
- **Practice address phone:** (262) 338-6444
- **Practice address fax:** (262) 338-3635
- **Mailing address:** PO BOX 553, WEST BEND, WI 53095-0553
- **Mailing address phone:** (262) 338-6444
- **Mailing address fax:** (262) 338-3635

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 879242 | WI | Yes |

## Other

- **Enumeration date:** 10/16/2006
- **Last updated:** 11/23/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 36222100 | — | WI |
| 01 | — | 5110515 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |