MEDICARE: MARIA DEBELLIS RPH

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	RP036575L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP036575L	OTHER	PA	LICENSE

General Provider Information

NPI Number	:	1245791193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA DEBELLIS RPH

Provider Business Mailing Address
First Line	:	44 WOODBINE LN
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17821-8020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 WOODBINE LN
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17821-8020
Country	:	US
Telephone Number	:	570-271-5508
Fax Number	:

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

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	03/25/2019

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