MEDICARE: BELLE DRUG, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1720549512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLE DRUG, LLC

Provider Business Mailing Address
First Line	:	2411 N BROADWAY AVE
Second Line	:
City	:	MILLER
State	:	SD
Zip	:	57362-1806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 5TH AVE
Second Line	:
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-1214
Country	:	US
Telephone Number	:	605-690-7737
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	TRAVIS ANDERBERG
Credential	:
Telephone Number	:	605-690-7737

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	03/26/2019

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Directions to “BELLE DRUG, LLC ” Practice Location

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