MEDICARE: ERIC BARDINE BELLDINA RPH, MS

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	WV 5073	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WV5073	OTHER	WV	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1598778227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC BARDINE BELLDINA RPH, MS

Provider Business Mailing Address
First Line	:	PO BOX 112
Second Line	:
City	:	MASONTOWN
State	:	WV
Zip	:	26542-0112
Country	:	US
Telephone Number	:	304-864-4000
Fax Number	:	304-864-3727

Provider Business Practice Location Address
First Line	:	303 MAIN STREET
Second Line	:
City	:	MASONTOWN
State	:	WV
Zip	:	26542-0112
Country	:	US
Telephone Number	:	304-864-4000
Fax Number	:	304-864-3727

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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