Organization
BERRY PHARMACY AND WELLNESS SERVICES LLC
Active
Other names
WEST BEND PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS BERRY RPH (PRESIDENT)
(262) 338-6444
Entity
Organization
Contact information
Practice address
1709 S 18TH AVE, WEST BEND, WI 53095-7808
(262) 338-6444
(262) 338-3635
Mailing address
PO BOX 553, WEST BEND, WI 53095-0553
(262) 338-6444
(262) 338-3635
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
879242
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36222100
—
WI
01
—
5110515
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/16/2006
Last updated
11/23/2010
Update your record
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