Healthcare Provider Details

I. General information

NPI: 1639210362
Provider Name (Legal Business Name): BAY PHARMACIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 EGG HARBOR RD
STURGEON BAY WI
54235-1277
US

IV. Provider business mailing address

1300 EGG HARBOR RD
STURGEON BAY WI
54235-1277
US

V. Phone/Fax

Practice location:
  • Phone: 920-746-2977
  • Fax: 920-746-2968
Mailing address:
  • Phone: 920-746-2977
  • Fax: 920-746-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number6547-042
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TANAPONG CHAIRIN
Title or Position: SEC/TREAS
Credential: RPH
Phone: 920-746-2977