=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851593560
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELVILLE ENTERPRISES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2007
-----------------------------------------------------
Last Update Date | 01/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10140 BARNES CANYON RD
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92121-2724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-652-6900
-----------------------------------------------------
Fax | 858-652-6999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11407 DEPARTMENT #2672
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35246-2672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-652-6900
-----------------------------------------------------
Fax | 858-652-6999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RONALD BELVILLE
-----------------------------------------------------
Credential | PHRMD
-----------------------------------------------------
Telephone | 619-992-7499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | PHY48682
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------