Provider Demographics
NPI:1033505771
Name:BELLEVILLE PHARMACY, LLC
Entity Type:Organization
Organization Name:BELLEVILLE PHARMACY, LLC
Other - Org Name:BELLEVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:HASHEM
Authorized Official - Middle Name:ADNAN
Authorized Official - Last Name:ACHKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-402-2521
Mailing Address - Street 1:25 OWEN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2921
Mailing Address - Country:US
Mailing Address - Phone:734-325-7658
Mailing Address - Fax:734-325-7654
Practice Address - Street 1:25 OWEN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2921
Practice Address - Country:US
Practice Address - Phone:734-325-7658
Practice Address - Fax:734-325-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010107053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy