Healthcare Provider Details

I. General information

NPI: 1790273944
Provider Name (Legal Business Name): HARBOUR BAY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 SE OCEAN BLVD STE B
STUART FL
34996
US

IV. Provider business mailing address

3754 SE OCEAN BLVD STE B
STUART FL
34996-6700
US

V. Phone/Fax

Practice location:
  • Phone: 844-407-3681
  • Fax: 561-529-3117
Mailing address:
  • Phone: 844-407-3681
  • Fax: 561-529-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LINDA YUN YUN
Title or Position: MANAGING MEMBER
Credential:
Phone: 917-757-3793