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General NPI Number Information
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NPI Number | 1386961704
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Entity Type | Individual
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Provider Name | MR. MICHAEL LEE BELLISH
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Gender | Male
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Dates
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Enumeration Date | 04/24/2010
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Last Update Date | 04/24/2010
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Provider Practice Location Address
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Address Line | 95 ATLANTIC CITY BLVD
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City | BEACHWOOD
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State | NJ
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Zip | 08722-2901
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Country | US
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Telephone | 732-505-8784
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Fax | 732-505-1598
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Provider Business Mailing Address
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Address Line | 66 SIERRA CT
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City | OLD BRIDGE
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State | NJ
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Zip | 08857-3050
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Country | US
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Telephone | 732-679-1056
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Fax | 732-952-3665
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI02857000
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License Number State | NJ
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