Provider Demographics
NPI:1104823194
Name:BELLDINA'S HEALTH MART PHARMACY, LLC
Entity Type:Organization
Organization Name:BELLDINA'S HEALTH MART PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:B
Authorized Official - Last Name:BELLDINA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:304-864-4000
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26542-0112
Mailing Address - Country:US
Mailing Address - Phone:304-864-4000
Mailing Address - Fax:304-864-3727
Practice Address - Street 1:107 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:WV
Practice Address - Zip Code:26542-4000
Practice Address - Country:US
Practice Address - Phone:304-864-4000
Practice Address - Fax:304-864-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVMP0552272332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4100980001Medicare NSC