Healthcare Provider Details

I. General information

NPI: 1073950853
Provider Name (Legal Business Name): BELMONT PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 2ND ST
BELMONT MS
38827-0876
US

IV. Provider business mailing address

PO BOX 876 338 2ND ST
BELMONT MS
38827-0876
US

V. Phone/Fax

Practice location:
  • Phone: 256-460-5761
  • Fax:
Mailing address:
  • Phone: 256-460-5761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM EUGENE WEATHERFORD
Title or Position: OWNER/PHARMACIST
Credential: R.PH
Phone: 256-460-5761