Provider Demographics
NPI:1407177876
Name:BELLANTI, MARY (RPH)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:BELLANTI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:RAPPL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:107 PICKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2711
Mailing Address - Country:US
Mailing Address - Phone:716-838-2311
Mailing Address - Fax:
Practice Address - Street 1:525 DIVISION ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-4403
Practice Address - Country:US
Practice Address - Phone:716-694-3138
Practice Address - Fax:716-694-3139
Is Sole Proprietor?:No
Enumeration Date:2010-06-19
Last Update Date:2010-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist