Provider Demographics
NPI:1689148447
Name:BILELLO, MARK ANTHONY (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:BILELLO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5817 VIEWPOINT AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-8369
Mailing Address - Country:US
Mailing Address - Phone:540-525-7351
Mailing Address - Fax:
Practice Address - Street 1:5817 VIEWPOINT AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-8369
Practice Address - Country:US
Practice Address - Phone:540-525-7351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022097611835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
431383OtherNABP
VA0202209761OtherBOARD OF PHARMACY