Healthcare Provider Details

I. General information

NPI: 1396756714
Provider Name (Legal Business Name): RICHARD L BERRY JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 N MEADE ST
APPLETON WI
54911-3454
US

IV. Provider business mailing address

5190 CHESAPEAKE CT
OSHKOSH WI
54901-1328
US

V. Phone/Fax

Practice location:
  • Phone: 920-831-6188
  • Fax: 920-831-5100
Mailing address:
  • Phone: 920-303-0682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10987
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: