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General NPI Number Information
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NPI Number | 1023440690
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Entity Type | Organization
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Legal Business Name | PHARMACY IN THE BAY,LLC
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 1140 HIGHWAY 90
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City | BAY ST LOUIS
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State | MS
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Zip | 39520-2451
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Country | US
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Telephone | 228-270-1055
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2547
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City | BAY ST LOUIS
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State | MS
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Zip | 39521-2547
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Country | US
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Telephone | 228-270-1055
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MR. RUDY ALLEN LETELLIER
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Credential | RPH
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Telephone | 228-270-1055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 12534/1.1
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License Number State | MS
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