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General NPI Number Information
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NPI Number | 1699070896
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Entity Type | Organization
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Legal Business Name | BERRY PHARMACIST GROUP LLC
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 912 KENTON STATION DR
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City | MAYSVILLE
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State | KY
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Zip | 41056-9658
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Country | US
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Telephone | 606-759-0700
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Fax | 606-759-0708
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Provider Business Mailing Address
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Address Line | 912 KENTON STATION DR
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City | MAYSVILLE
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State | KY
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Zip | 41056-9658
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Country | US
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Telephone | 606-759-0700
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Fax | 606-759-0708
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Authorized Official
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Title or Position | PIC/OWNER
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Name | DR. ROBERT MICHAEL BERRY
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Credential | PHARM-D
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Telephone | 606-584-0401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P07435
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License Number State | KY
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