Healthcare Provider Details

I. General information

NPI: 1851570147
Provider Name (Legal Business Name): BAY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 HIGHWAY 155
LOCUST GROVE GA
30248-3513
US

IV. Provider business mailing address

PO BOX 1028
MCDONOUGH GA
30253-1028
US

V. Phone/Fax

Practice location:
  • Phone: 770-957-0040
  • Fax: 770-957-0042
Mailing address:
  • Phone: 770-957-0040
  • Fax: 770-957-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009432
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RONNIE JEFFEARS
Title or Position: OWNER
Credential:
Phone: 770-957-0040