Provider Demographics
NPI:1205024064
Name:BELISLE, TERI RENEE (PHARMD, RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:TERI
Middle Name:RENEE
Last Name:BELISLE
Suffix:
Gender:F
Credentials:PHARMD, RD, CDE
Other - Prefix:MS
Other - First Name:TERI
Other - Middle Name:RENEE
Other - Last Name:GIORDANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RD, CDE
Mailing Address - Street 1:13260 ROMANY WAY CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1610
Mailing Address - Country:US
Mailing Address - Phone:314-330-2511
Mailing Address - Fax:
Practice Address - Street 1:13260 ROMANY WAY CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1610
Practice Address - Country:US
Practice Address - Phone:314-330-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-290116183500000X
FLPS 39397183500000X
IL164006124133V00000X
MO2016002768183500000X
MO2016008551133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered