Healthcare Provider Details

I. General information

NPI: 1164419974
Provider Name (Legal Business Name): PAUL PHILIP BELLIVEAU PHARM.D., R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 NICHOLS RD
FITCHBURG MA
01420-1931
US

IV. Provider business mailing address

18 NATHANIEL DR
HUDSON NH
03051-5075
US

V. Phone/Fax

Practice location:
  • Phone: 978-665-5901
  • Fax:
Mailing address:
  • Phone: 603-883-3906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number21270
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: