MEDICARE: BAY STREET 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	3336C0004X	Compounding Pharmacy
2	333600000X	Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	3336C0003X	Community/Retail Pharmacy	PH8549	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2007320	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588669063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY STREET PHARMACY INC

Provider Business Mailing Address
First Line	:	7746 BAY STREET
Second Line	:
City	:	SEBASTIAN
State	:	FL
Zip	:	32958
Country	:	US
Telephone Number	:	772-589-2043
Fax Number	:	772-388-2628

Provider Business Practice Location Address
First Line	:	7746 BAY ST
Second Line	:
City	:	SEBASTIAN
State	:	FL
Zip	:	32958-3427
Country	:	US
Telephone Number	:	772-589-2043
Fax Number	:	772-388-2628

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THERESA TOLLE
Credential	:	RPH
Telephone Number	:	772-589-2043

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/29/2022

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1558429548 — MR. ROBERT LITTLETON RPH
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Directions to “BAY STREET PHARMACY INC ” Practice Location

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