Provider Demographics
NPI:1245559301
Name:B7 PHARMACY INC
Entity Type:Organization
Organization Name:B7 PHARMACY INC
Other - Org Name:GOOD VALUE PHARMACY MEDCARE WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:BERCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:262-925-0201
Mailing Address - Street 1:9916 75TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7583
Mailing Address - Country:US
Mailing Address - Phone:262-925-0201
Mailing Address - Fax:262-925-8373
Practice Address - Street 1:9916 75TH ST STE 103
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7583
Practice Address - Country:US
Practice Address - Phone:262-925-0201
Practice Address - Fax:262-925-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WI9007-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1245559301Medicaid
2125171OtherPK
3954760003Medicare NSC