Healthcare Provider Details

I. General information

NPI: 1588669063
Provider Name (Legal Business Name): BAY STREET PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7746 BAY ST
SEBASTIAN FL
32958-3427
US

IV. Provider business mailing address

7746 BAY STREET
SEBASTIAN FL
32958
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 TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH8549
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

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