Healthcare Provider Details

I. General information

NPI: 1689148447
Provider Name (Legal Business Name): MARK ANTHONY BILELLO R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5817 VIEWPOINT AVE
SALEM VA
24153-8369
US

IV. Provider business mailing address

5817 VIEWPOINT AVE
SALEM VA
24153-8369
US

V. Phone/Fax

Practice location:
  • Phone: 540-525-7351
  • Fax:
Mailing address:
  • Phone: 540-525-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0202209761
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: