MEDICARE: MRS. TERI RENEE BELISLE PHARMD, RD, CDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	051-290116	IL
2	183500000X	Pharmacist	PS 39397	FL
3	133V00000X	Registered Dietitian	164006124	IL
4	183500000X	Pharmacist	2016002768	MO
5	133V00000X	Registered Dietitian	2016008551	MO

General Provider Information

NPI Number	:	1205024064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERI RENEE BELISLE PHARMD, RD, CDE

Provider Business Mailing Address
First Line	:	13260 ROMANY WAY CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1610
Country	:	US
Telephone Number	:	314-330-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	13260 ROMANY WAY CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1610
Country	:	US
Telephone Number	:	314-330-2511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	03/27/2017

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