Provider Demographics
NPI:1720375512
Name:BELARDO, MARK ANTONIO SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTONIO
Last Name:BELARDO
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1245 N MILITARY HWY
Mailing Address - Street 2:TARGET STORE 1048
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-2228
Mailing Address - Country:US
Mailing Address - Phone:757-461-9356
Mailing Address - Fax:757-461-9356
Practice Address - Street 1:1245 N MILITARY HWY
Practice Address - Street 2:TARGET STORE 1048
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2228
Practice Address - Country:US
Practice Address - Phone:757-461-9356
Practice Address - Fax:757-461-9356
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0202012576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist