Provider Demographics
NPI:1952673873
Name:BELLFORT RX LLC
Entity Type:Organization
Organization Name:BELLFORT RX LLC
Other - Org Name:ANGLETON HEALTH MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:DIRAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-741-1176
Mailing Address - Street 1:12234 SHADOW CREEK PKWY STE 4110
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7333
Mailing Address - Country:US
Mailing Address - Phone:281-741-1176
Mailing Address - Fax:979-401-0009
Practice Address - Street 1:12234 SHADOW CREEK PKWY STE 4110
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7333
Practice Address - Country:US
Practice Address - Phone:281-741-1176
Practice Address - Fax:979-401-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5905091OtherNCPDP PROVIDER IDENTIFICATION NUMBER