Provider Demographics
NPI:1316988272
Name:BERRY DRUGS INC
Entity type:Organization
Organization Name:BERRY DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:231-879-4243
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:FIFE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49633-0098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 STATE ST
Practice Address - Street 2:
Practice Address - City:FIFE LAKE
Practice Address - State:MI
Practice Address - Zip Code:49633
Practice Address - Country:US
Practice Address - Phone:231-879-4243
Practice Address - Fax:231-879-4943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 332B00000X
MI5301006831333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2339821Medicaid
2339821OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MI5095660001Medicare NSC