Provider Demographics
NPI:1740630862
Name:BELLEVUE PHARMACY LLC
Entity type:Organization
Organization Name:BELLEVUE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KAPIAMBA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTEBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-404-6067
Mailing Address - Street 1:3939 S CAPITOL ST SW
Mailing Address - Street 2:SUITE C1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2308
Mailing Address - Country:US
Mailing Address - Phone:301-404-6067
Mailing Address - Fax:
Practice Address - Street 1:3939 S CAPITOL ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2308
Practice Address - Country:US
Practice Address - Phone:202-629-4221
Practice Address - Fax:202-629-4592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy