Organization
BELAVISTA PHARMACY INC
Active
Other names
BELAVISTA PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
ALI NASSAR (PRESIDENT)
(313) 485-1411
Entity
Organization
Contact information
Practice address
347 INKSTER RD, INKSTER, MI 48141-1208
(313) 563-5300
(313) 563-5353
Mailing address
347 INKSTER RD, INKSTER, MI 48141-1208
(313) 563-5300
(313) 563-5353
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301007885
MI
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2365814
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
874667074
—
MI
Enumeration date
08/10/2006
Last updated
08/10/2012
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