Provider Demographics
NPI:1801483649
Name:BELLEISLE, REBECCA RAE (RPH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:RAE
Last Name:BELLEISLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:RAE
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-3502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-3502
Practice Address - Country:US
Practice Address - Phone:512-474-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH235268183500000X
TX60977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist