MEDICARE: GAYLYN E BELLAIRE 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	14692	LA

General Provider Information

NPI Number	:	1598071714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLYN E BELLAIRE RPH

Provider Business Mailing Address
First Line	:	5061 MAIN ST
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791-3947
Country	:	US
Telephone Number	:	225-654-1335
Fax Number	:	225-654-6195

Provider Business Practice Location Address
First Line	:	5061 MAIN ST
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791-3947
Country	:	US
Telephone Number	:	225-654-1335
Fax Number	:	225-654-6195

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

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	08/25/2010

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Directions to “ GAYLYN E BELLAIRE RPH” Practice Location

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