Active NPI
Kenneth Raymond Bellisle, R.PH
- Pharmacist
- Hickam Afb, HI
National Provider Identifier
1669623690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH-1332
- Practice address
- 755 Scott Cir
15TH Medical Group
Hickam Afb, HI 96853-5399 - Phone
- (808) 448-6261
- Fax
- (808) 448-6740
- NPI assigned
- Oct 8, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH-1332 | HI | Primary |
Addresses
Primary practice location
755 Scott Cir
15TH Medical Group
Hickam Afb, HI 96853-5399
Mailing address
755 Scott Cir
15TH Medical Group
Hickam Afb, HI 96853-5399
Phone (808) 448-6261
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH-1332 | HI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223424000000",
"number": "1669623690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "755 SCOTT CIR",
"address_2": "15TH MEDICAL GROUP",
"city": "HICKAM AFB",
"state": "HI",
"postal_code": "968535399",
"telephone_number": "808-448-6261",
"fax_number": "808-448-6740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "755 SCOTT CIR",
"address_2": "15TH MEDICAL GROUP",
"city": "HICKAM AFB",
"state": "HI",
"postal_code": "968535399",
"telephone_number": "808-448-6261",
"fax_number": "808-448-6740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BELLISLE",
"first_name": "KENNETH",
"middle_name": "RAYMOND",
"name_prefix": "Mr.",
"credential": "R.PH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-10-08",
"last_updated": "2008-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "HI",
"license": "PH-1332",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hickam Afb, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.