Healthcare Provider Details

I. General information

NPI: 1093675597
Provider Name (Legal Business Name): BAY PARK PHARMACY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 NEPTUNE AVE
BROOKLYN NY
11224-1675
US

IV. Provider business mailing address

3355 NEPTUNE AVE
BROOKLYN NY
11224-1675
US

V. Phone/Fax

Practice location:
  • Phone: 718-372-2700
  • Fax: 718-372-2744
Mailing address:
  • Phone: 718-372-2700
  • Fax: 718-372-2744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ARIE BOLSHEM
Title or Position: PRESIDENT
Credential:
Phone: 718-372-2700