Organization
BELFY DRUG STORE INC
Active
Other names
MAIN STREET PHARMACY AND GIFTS
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY SOEKARMOEN RPH (OWNER)
(269) 649-1476
Entity
Organization
Contact information
Practice address
387 N MAIN ST, WATERVLIET, MI 49098-9795
(269) 463-3164
(269) 639-2524
Mailing address
PO BOX 97, WATERVLIET, MI 49098-0097
(269) 637-1161
(269) 639-2524
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301007951
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1964404
—
MI
01
—
2320769
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
871970152
—
MI
Enumeration date
05/27/2006
Last updated
06/23/2009
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