Provider Demographics
NPI:1497713812
Name:BELLEVIEW COMMUNITY PHARMACY, LLC
Entity Type:Organization
Organization Name:BELLEVIEW COMMUNITY PHARMACY, LLC
Other - Org Name:BELLEVIEW COMMUNITY PHARMACY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIMI
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA
Authorized Official - Phone:352-427-8680
Mailing Address - Street 1:10762 SE US HWY 441
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-3805
Mailing Address - Country:US
Mailing Address - Phone:352-347-4064
Mailing Address - Fax:352-347-6832
Practice Address - Street 1:2500 CITRUS BLVD.
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3063
Practice Address - Country:US
Practice Address - Phone:352-728-0477
Practice Address - Fax:352-315-3836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH21895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031408100Medicaid
FL031408101Medicaid
1094185OtherNCPDP PROVIDER ID #
4353020001Medicare NSC