Provider Demographics
NPI:1760774368
Name:BELLE, EUGENE
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:
Last Name:BELLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2927
Mailing Address - Country:US
Mailing Address - Phone:978-630-2808
Mailing Address - Fax:
Practice Address - Street 1:255 NORTH RD
Practice Address - Street 2:UNIT 97
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1411
Practice Address - Country:US
Practice Address - Phone:978-256-1617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH14569183500000X
NHR1818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist