Provider Demographics
NPI:1295044816
Name:BERRY OAKS PHARMACY, LLC
Entity Type:Organization
Organization Name:BERRY OAKS PHARMACY, LLC
Other - Org Name:BERRY OAKS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NEWBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:512-478-6419
Mailing Address - Street 1:19851 WEST HIGHWAY 46 STE 204
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070
Mailing Address - Country:US
Mailing Address - Phone:830-980-5308
Mailing Address - Fax:830-980-5309
Practice Address - Street 1:19851 WEST HIGHWAY 46 STE 204
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070
Practice Address - Country:US
Practice Address - Phone:830-980-5308
Practice Address - Fax:830-980-5309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy