Provider Demographics
NPI:1689744286
Name:B7 PHARMACY, INC.
Entity Type:Organization
Organization Name:B7 PHARMACY, INC.
Other - Org Name:GOOD VALUE PHARMACY LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERCE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:262-697-5744
Mailing Address - Street 1:9916 75TH ST
Mailing Address - Street 2:SUITE 203
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:262-925-0202
Practice Address - Street 1:9916 75TH ST
Practice Address - Street 2:SUITE 203
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:262-925-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9012-0423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33278800Medicaid
WI3954760002Medicare NSC