Healthcare Provider Details

I. General information

NPI: 1568485829
Provider Name (Legal Business Name): BELVIDERE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 GREENWICH ST
BELVIDERE NJ
07823-1449
US

IV. Provider business mailing address

15 GREENWICH ST
BELVIDERE NJ
07823-1449
US

V. Phone/Fax

Practice location:
  • Phone: 908-475-1060
  • Fax: 908-475-1130
Mailing address:
  • Phone: 908-475-1060
  • Fax: 908-475-1130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00634600
License Number StateNJ

VIII. Authorized Official

Name: NITANG PATEL
Title or Position: OWNER
Credential:
Phone: 908-475-1060