Healthcare Provider Details

I. General information

NPI: 1437989928
Provider Name (Legal Business Name): BAYVRIO PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1548 E FOWLER AVE
TAMPA FL
33612-5416
US

IV. Provider business mailing address

1548 E FOWLER AVE
TAMPA FL
33612-5416
US

V. Phone/Fax

Practice location:
  • Phone: 813-623-1800
  • Fax: 813-985-1700
Mailing address:
  • Phone: 813-623-1800
  • Fax: 813-985-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY JOHNSON
Title or Position: CEO
Credential:
Phone: 813-623-1800