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General NPI Number Information
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NPI Number | 1851385348
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Entity Type | Organization
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Legal Business Name | BELAVISTA DRUGS
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Dates
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Enumeration Date | 09/10/2005
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Last Update Date | 09/17/2009
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Provider Practice Location Address
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Address Line | 15830 FORT ST SUITE 5
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City | SOUTHGATE
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State | MI
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Zip | 48195-1367
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Country | US
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Telephone | 734-282-1940
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Fax | 734-282-1953
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Provider Business Mailing Address
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Address Line | 15830 FORT ST SUITE 5
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City | SOUTHGATE
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State | MI
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Zip | 48195-1367
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Country | US
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Telephone | 734-282-1940
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Fax | 734-282-1953
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Authorized Official
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Title or Position | REGISTERED PHARMACIST
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Name | MR. JIHAD H BEYDOUN
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Credential | R,PH
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Telephone | 734-282-1940
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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 | 5301008225
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301008225
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License Number State | MI
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