Healthcare Provider Details

I. General information

NPI: 1821326919
Provider Name (Legal Business Name): BAYRX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 INTERNATIONAL BLVD STE A
OAKLAND CA
94601-1555
US

IV. Provider business mailing address

2700 INTERNATIONAL BLVD STE A
OAKLAND CA
94601-1555
US

V. Phone/Fax

Practice location:
  • Phone: 510-532-1002
  • Fax: 515-532-1011
Mailing address:
  • Phone: 510-532-1002
  • Fax: 515-532-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY50028
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA GOLUNOVA
Title or Position: OWNER / VP
Credential: CPHT
Phone: 510-532-1002