Healthcare Provider Details

I. General information

NPI: 1295842839
Provider Name (Legal Business Name): BELLEVUE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 STATE ST
BELLEVUE IA
52031-1307
US

IV. Provider business mailing address

115 STATE ST
BELLEVUE IA
52031-1307
US

V. Phone/Fax

Practice location:
  • Phone: 563-872-4259
  • Fax: 563-872-4837
Mailing address:
  • Phone: 563-872-4259
  • Fax: 563-872-4837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number494
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number494
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number494
License Number StateIA

VIII. Authorized Official

Name: PATRICIA MCCLIMON
Title or Position: MANAGER
Credential: RN
Phone: 563-872-4259