Provider Demographics
NPI:1083910640
Name:BELMONT PHARMACY LLC
Entity Type:Organization
Organization Name:BELMONT PHARMACY LLC
Other - Org Name:BELMONT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAUSHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-667-6989
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19058-0429
Mailing Address - Country:US
Mailing Address - Phone:215-915-6989
Mailing Address - Fax:888-979-2677
Practice Address - Street 1:3571 HULMEVILLE RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4311
Practice Address - Country:US
Practice Address - Phone:215-645-1527
Practice Address - Fax:267-523-5861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4821133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143901OtherPK
PA1028977100001Medicaid