1083910640 NPI number — BELMONT PHARMACY LLC

Table of content: (NPI 1083910640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083910640 NPI number — BELMONT PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELMONT PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BELMONT PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083910640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 429
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEVITTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19058-0429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-915-6989
Provider Business Mailing Address Fax Number:
888-979-2677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3571 HULMEVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENSALEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19020-4311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-645-1527
Provider Business Practice Location Address Fax Number:
267-523-5861
Provider Enumeration Date:
01/31/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
KAUSHAL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
917-667-6989

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PP482113 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2143901 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1028977100001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".