Healthcare Provider Details

I. General information

NPI: 1265377568
Provider Name (Legal Business Name): BAY VALLEY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 BROAD ST
STATEN ISLAND NY
10304-2608
US

IV. Provider business mailing address

47 BROAD ST
STATEN ISLAND NY
10304-2608
US

V. Phone/Fax

Practice location:
  • Phone: 347-861-0091
  • Fax: 347-861-0563
Mailing address:
  • Phone: 347-861-0091
  • Fax: 347-861-0563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: IMRAN ALI
Title or Position: PRESIDENT
Credential:
Phone: 347-861-0091