Healthcare Provider Details

I. General information

NPI: 1821189598
Provider Name (Legal Business Name): BELLAIRE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N BRIDGE ST
BELLAIRE MI
49615-5105
US

IV. Provider business mailing address

PO BOX 272
BELLAIRE MI
49615-0272
US

V. Phone/Fax

Practice location:
  • Phone: 231-533-8014
  • Fax: 231-533-6697
Mailing address:
  • Phone: 231-533-8014
  • Fax: 231-533-6697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301005694
License Number StateMI

VIII. Authorized Official

Name: KENNETH FIFELSKI
Title or Position: OWNER
Credential: RPH
Phone: 231-533-8014