Provider Demographics
NPI:1073839072
Name:BELMORE, JENNIFER JERAULD (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JERAULD
Last Name:BELMORE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1743
Mailing Address - Country:US
Mailing Address - Phone:607-798-0343
Mailing Address - Fax:607-798-1439
Practice Address - Street 1:711 MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1743
Practice Address - Country:US
Practice Address - Phone:607-798-0343
Practice Address - Fax:607-798-1439
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist