Provider Demographics
NPI:1336556711
Name:MID-BELL, LLC
Entity type:Organization
Organization Name:MID-BELL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MIDLARSKY BELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-329-1821
Mailing Address - Street 1:12144 CENTRAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2420
Mailing Address - Country:US
Mailing Address - Phone:909-591-8444
Mailing Address - Fax:909-613-1560
Practice Address - Street 1:12144 CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2420
Practice Address - Country:US
Practice Address - Phone:909-591-8444
Practice Address - Fax:909-613-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
CAPHY560603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146900OtherPK