=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235433921
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAYHEALTH MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2011
-----------------------------------------------------
Last Update Date | 04/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 WELLNESS WAY
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19963-4364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-430-5150
-----------------------------------------------------
Fax | 302-430-5155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 WELLNESS WAY
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19963-4364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-430-5150
-----------------------------------------------------
Fax | 302-430-5155
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AMBULATORY PHARMACY MANAGER
-----------------------------------------------------
Name | MADELINE BYRNE
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 302-744-6617
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0002X
-----------------------------------------------------
Taxonomy Name | Clinic Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------