MEDICARE: BAYSHORE PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	24424	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2098839	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407872658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYSHORE PHARMACY INC

Provider Business Mailing Address
First Line	:	3315 BURKE RD STE 201
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1823
Country	:	US
Telephone Number	:	832-606-2583
Fax Number	:	713-944-8890

Provider Business Practice Location Address
First Line	:	3315 BURKE RD STE 201
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1823
Country	:	US
Telephone Number	:	713-944-8893
Fax Number	:	713-944-8890

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALI HAIJA
Credential	:	RPH
Telephone Number	:	832-606-2583

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/05/2022

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Directions to “BAYSHORE PHARMACY INC ” Practice Location

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