Provider Demographics
NPI:1487770426
Name:BELGARDE, ALLEN S (RPH)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:S
Last Name:BELGARDE
Suffix:
Gender:M
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 658
Mailing Address - Street 2:
Mailing Address - City:DUNSEITH
Mailing Address - State:ND
Mailing Address - Zip Code:58329-0658
Mailing Address - Country:US
Mailing Address - Phone:701-244-5134
Mailing Address - Fax:
Practice Address - Street 1:HWY 5
Practice Address - Street 2:QUENTIN N. BURDICK COMPREHENSIVE HEALTH CARE FACILITY
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-477-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist