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General NPI Number Information
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NPI Number | 1396982666
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Entity Type | Organization
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Legal Business Name | NEW BERLIN PHARMACY INC
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 14105 W GREENFIELD AVE
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City | NEW BERLIN
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State | WI
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Zip | 53151-1640
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Country | US
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Telephone | 262-782-0460
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Fax | 262-782-4124
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Provider Business Mailing Address
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Address Line | 14105 W GREENFIELD AVE
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City | NEW BERLIN
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State | WI
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Zip | 53151-1640
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Country | US
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Telephone | 262-782-0460
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Fax | 262-782-4124
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Authorized Official
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Title or Position | OWNER
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Name | JASON KILVINGER
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Credential |
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Telephone | 414-881-2766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 8899042
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License Number State | WI
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