Provider Demographics
NPI:1720373533
Name:BELVISO, KELLY ANN (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:BELVISO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S RIVER RD
Mailing Address - Street 2:2009
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6819
Mailing Address - Country:US
Mailing Address - Phone:603-263-0062
Mailing Address - Fax:603-263-0062
Practice Address - Street 1:220 S RIVER RD
Practice Address - Street 2:2009
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6819
Practice Address - Country:US
Practice Address - Phone:603-263-0062
Practice Address - Fax:603-263-0062
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR1317183500000X
MEPR3998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist