Provider Demographics
NPI:1598752941
Name:BELSAY MEDICAL PHARMACY INC
Entity Type:Organization
Organization Name:BELSAY MEDICAL PHARMACY INC
Other - Org Name:BELSAY MEDICAL PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/RPH
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:810-715-1415
Mailing Address - Street 1:1096 S BELSAY RD STE I
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1948
Mailing Address - Country:US
Mailing Address - Phone:810-715-1415
Mailing Address - Fax:810-715-1404
Practice Address - Street 1:1096 S BELSAY RD STE I
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1948
Practice Address - Country:US
Practice Address - Phone:810-715-1415
Practice Address - Fax:810-715-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010064453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2355990OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MI3264002Medicaid