Healthcare Provider Details

I. General information

NPI: 1447250857
Provider Name (Legal Business Name): BELLEVIEW COMMUNITY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10762 SE US HIGHWAY 441
BELLEVIEW FL
34420-3805
US

IV. Provider business mailing address

10762 SE US HIGHWAY 441
BELLEVIEW FL
34420-3805
US

V. Phone/Fax

Practice location:
  • Phone: 352-347-4064
  • Fax: 352-347-6832
Mailing address:
  • Phone: 352-347-4064
  • Fax: 352-347-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH18200
License Number StateFL

VIII. Authorized Official

Name: MICHAEL CRIMI
Title or Position: OWNER
Credential:
Phone: 352-347-4064