MEDICARE: JILL BELKA RP

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	10594	NE

General Provider Information

NPI Number	:	1538289301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL BELKA RP

Provider Business Mailing Address
First Line	:	702 E BRIARWOOD LN
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-9084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 N JEFFERS ST
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-3931
Country	:	US
Telephone Number	:	308-532-7010
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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Directions to “ JILL BELKA RP” Practice Location

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