Provider Demographics
NPI:1104120229
Name:BELLEN, STEVEN WAYNE (PHARMD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:WAYNE
Last Name:BELLEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 N HICKS RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-3608
Mailing Address - Country:US
Mailing Address - Phone:847-963-4175
Mailing Address - Fax:855-795-5403
Practice Address - Street 1:545 N HICKS RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-3608
Practice Address - Country:US
Practice Address - Phone:847-963-4175
Practice Address - Fax:855-795-5403
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60101467183500000X
IL051294719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist