Individual
MR. PHYLLIS ANNE BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1757 W KIRBY AVE, CHAMPAIGN, IL 61821-5500
(217) 383-3398
(217) 359-7063
Mailing address
2112 WIGGINS ST, CHAMPAIGN, IL 61822-3601
(217) 356-4825
(217) 359-7063
Taxonomy
Speciality
Code
Description
License number
State
1835P1200X
Pharmacotherapy Pharmacist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371119538015
—
IL
Enumeration date
12/26/2006
Last updated
07/08/2007
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