Provider Demographics
NPI:1124486709
Name:REAUME, BELINDA (RPH)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:
Last Name:REAUME
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:10200 SHEELER ROAD
Mailing Address - City:ONSTED
Mailing Address - State:MI
Mailing Address - Zip Code:49265-0468
Mailing Address - Country:US
Mailing Address - Phone:517-605-0472
Mailing Address - Fax:
Practice Address - Street 1:1601 E US HIGHWAY 223
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-4454
Practice Address - Country:US
Practice Address - Phone:517-265-9686
Practice Address - Fax:517-265-9870
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302024841OtherPHARMACY LICENSE