Provider Demographics
NPI:1891240289
Name:BEREI, THEODORE JOSEPH (PHARMD, MBA)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:JOSEPH
Last Name:BEREI
Suffix:
Gender:M
Credentials:PHARMD, MBA
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Mailing Address - Street 1:600 HIGHLAND AVENUE
Mailing Address - Street 2:UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53792
Mailing Address - Country:US
Mailing Address - Phone:608-263-1290
Mailing Address - Fax:608-263-9424
Practice Address - Street 1:600 HIGHLAND AVENUE, 1530
Practice Address - Street 2:UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792
Practice Address - Country:US
Practice Address - Phone:608-263-1290
Practice Address - Fax:608-263-9424
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI18253-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist