MEDICARE: BAYPHARM HEALTH SYSTEMS

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

General Provider Information

NPI Number	:	1932720356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYPHARM HEALTH SYSTEMS

Provider Business Mailing Address
First Line	:	1147 SE GRAHAM CT
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-2841
Country	:	US
Telephone Number	:	727-238-7672
Fax Number	:

Provider Business Practice Location Address
First Line	:	1147 SE GRAHAM CT
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-2841
Country	:	US
Telephone Number	:	727-238-7672
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL DOUGLAS DALEY
Credential	:	RPH
Telephone Number	:	727-238-7672

Provider Enumeration Date	:	04/27/2020
Last Update Date	:	04/27/2020

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