MEDICARE: BERRY DRUGS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy	5301006831	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2339821	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1316988272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERRY DRUGS INC

Provider Business Mailing Address
First Line	:	PO BOX 98
Second Line	:
City	:	FIFE LAKE
State	:	MI
Zip	:	49633-0098
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 STATE ST
Second Line	:
City	:	FIFE LAKE
State	:	MI
Zip	:	49633
Country	:	US
Telephone Number	:	231-879-4243
Fax Number	:	231-879-4943

Authorized Official
Title or Position	:	PRESIDENT AND OWNER
Name	:	RUTH BERRY
Credential	:	RPH
Telephone Number	:	231-879-4243

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	02/14/2008

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Directions to “BERRY DRUGS INC ” Practice Location

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