Healthcare Provider Details

I. General information

NPI: 1821045964
Provider Name (Legal Business Name): BELFY DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 N MAIN ST
WATERVLIET MI
49098-9795
US

IV. Provider business mailing address

PO BOX 97
WATERVLIET MI
49098-0097
US

V. Phone/Fax

Practice location:
  • Phone: 269-463-3164
  • Fax: 269-639-2524
Mailing address:
  • Phone: 269-637-1161
  • Fax: 269-639-2524

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 Number5301007951
License Number StateMI

VIII. Authorized Official

Name: KELLY SOEKARMOEN
Title or Position: OWNER
Credential: RPH
Phone: 269-649-1476