Healthcare Provider Details

I. General information

NPI: 1114723780
Provider Name (Legal Business Name): BAY STREET PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7746 BAY ST
SEBASTIAN FL
32958-3427
US

IV. Provider business mailing address

7746 BAY ST
SEBASTIAN FL
32958-3427
US

V. Phone/Fax

Practice location:
  • Phone: 772-589-2043
  • Fax: 772-388-2628
Mailing address:
  • Phone: 772-589-2043
  • Fax: 772-388-2628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THERESA TOLLE
Title or Position: PRESIDENT
Credential:
Phone: 772-589-2043