Healthcare Provider Details

I. General information

NPI: 1851593560
Provider Name (Legal Business Name): BELVILLE ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10140 BARNES CANYON RD
SAN DIEGO CA
92121-2724
US

IV. Provider business mailing address

PO BOX 11407 DEPARTMENT #2672
BIRMINGHAM AL
35246-2672
US

V. Phone/Fax

Practice location:
  • Phone: 858-652-6900
  • Fax: 858-652-6999
Mailing address:
  • Phone: 858-652-6900
  • Fax: 858-652-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY48682
License Number StateCA

VIII. Authorized Official

Name: RONALD BELVILLE
Title or Position: OWNER
Credential: PHRMD
Phone: 619-992-7499