Provider Demographics
NPI:1598778227
Name:BELLDINA, ERIC BARDINE (RPH, MS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:BARDINE
Last Name:BELLDINA
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:MASONTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26542-0112
Mailing Address - Country:US
Mailing Address - Phone:304-864-4000
Mailing Address - Fax:304-864-3727
Practice Address - Street 1:303 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MASONTOWN
Practice Address - State:WV
Practice Address - Zip Code:26542-0112
Practice Address - Country:US
Practice Address - Phone:304-864-4000
Practice Address - Fax:304-864-3727
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 5073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV5073OtherPHARMACIST LICENSE