Provider Demographics
NPI:1437731221
Name:BELVEDERE PHARMACY LLC
Entity Type:Organization
Organization Name:BELVEDERE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANDOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-367-5710
Mailing Address - Street 1:3716 1/2 W BELVEDERE AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5708
Mailing Address - Country:US
Mailing Address - Phone:410-367-5710
Mailing Address - Fax:410-367-5639
Practice Address - Street 1:3716 1/2 W BELVEDERE AVE UNIT C
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5708
Practice Address - Country:US
Practice Address - Phone:410-367-5710
Practice Address - Fax:410-367-5639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELVEDERE PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy