MEDICARE: MR. MARK ANTONIO BELARDO SR. 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	0202012576	VA

General Provider Information

NPI Number	:	1720375512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK ANTONIO BELARDO SR. RPH.

Provider Business Mailing Address
First Line	:	1245 N MILITARY HWY
Second Line	:	TARGET STORE 1048
City	:	NORFOLK
State	:	VA
Zip	:	23502-2228
Country	:	US
Telephone Number	:	757-461-9356
Fax Number	:	757-461-9356

Provider Business Practice Location Address
First Line	:	1245 N MILITARY HWY
Second Line	:	TARGET STORE 1048
City	:	NORFOLK
State	:	VA
Zip	:	23502-2228
Country	:	US
Telephone Number	:	757-461-9356
Fax Number	:	757-461-9356

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

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	06/30/2011

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