Provider Demographics
NPI:1639434483
Name:BREWER, BARRY (RPH)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:BREWER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 N CHAPPELL DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-6890
Mailing Address - Country:US
Mailing Address - Phone:920-730-0799
Mailing Address - Fax:
Practice Address - Street 1:225 N EAGLE ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4125
Practice Address - Country:US
Practice Address - Phone:920-966-1345
Practice Address - Fax:920-966-1285
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9939-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist