Provider Demographics
NPI:1699948604
Name:BELLAIRE PHARMACY, LLC
Entity type:Organization
Organization Name:BELLAIRE PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-881-9660
Mailing Address - Street 1:11104 W AIRPORT BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3035
Mailing Address - Country:US
Mailing Address - Phone:713-777-6251
Mailing Address - Fax:713-988-6608
Practice Address - Street 1:11104 W AIRPORT BLVD STE 214
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3035
Practice Address - Country:US
Practice Address - Phone:713-777-6251
Practice Address - Fax:713-988-6608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X, 261QP3300X, 282NC0060X, 3104A0625X, 315D00000X, 332000000X, 332100000X, 332900000X, 333600000X, 3336C0003X, 3336L0003X, 3336M0002X, 3336S0011X
TX146673336C0003X
TX313653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No251G00000XAgenciesHospice Care, Community Based
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
No332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
No332900000XSuppliersNon-Pharmacy Dispensing Site
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4453880001Medicare NSC