Provider Demographics
NPI:1417357161
Name:BELLAY, MARYJANE KRUSE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARYJANE
Middle Name:KRUSE
Last Name:BELLAY
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 1:8907 HARNESS WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3345
Mailing Address - Country:US
Mailing Address - Phone:301-655-4361
Mailing Address - Fax:
Practice Address - Street 1:7955 BAYSIDE RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE BEACH
Practice Address - State:MD
Practice Address - Zip Code:20732-3112
Practice Address - Country:US
Practice Address - Phone:410-257-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-31
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD009270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD009270OtherPHARMACIST