Healthcare Provider Details

I. General information

NPI: 1417902255
Provider Name (Legal Business Name): BELLEVIEW COMMUNITY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CITRUS BLVD
LEESBURG FL
34748-3063
US

IV. Provider business mailing address

10762 SE US HIGHWAY 441
BELLEVIEW FL
34420-3805
US

V. Phone/Fax

Practice location:
  • Phone: 352-728-0477
  • Fax: 352-315-3836
Mailing address:
  • Phone: 352-347-4064
  • Fax: 352-347-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH21895
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL CRIMI
Title or Position: MGR
Credential:
Phone: 352-347-5225