Healthcare Provider Details

I. General information

NPI: 1033070230
Provider Name (Legal Business Name): NICHOLAS KELSEY BERRES PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E 2ND ST
RICHLAND CENTER WI
53581-1914
US

IV. Provider business mailing address

333 E 2ND ST
RICHLAND CENTER WI
53581-1914
US

V. Phone/Fax

Practice location:
  • Phone: 608-647-6321
  • Fax: 608-647-1849
Mailing address:
  • Phone: 608-647-6321
  • Fax: 608-647-1849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17190-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: