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General NPI Number Information
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NPI Number | 1720549512
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Entity Type | Organization
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Legal Business Name | BELLE DRUG, LLC
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 03/26/2019
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Provider Practice Location Address
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Address Line | 608 5TH AVE
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City | BELLE FOURCHE
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State | SD
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Zip | 57717-1214
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Country | US
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Telephone | 605-690-7737
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Fax |
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Provider Business Mailing Address
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Address Line | 2411 N BROADWAY AVE
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City | MILLER
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State | SD
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Zip | 57362-1806
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | TRAVIS ANDERBERG
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Credential |
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Telephone | 605-690-7737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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