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General NPI Number Information
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NPI Number | 1528513595
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Entity Type | Organization
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Legal Business Name | BAY STREET PHARMACY INC
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Dates
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Enumeration Date | 08/19/2016
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 7746 BAY ST
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City | SEBASTIAN
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State | FL
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Zip | 32958-3427
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Country | US
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Telephone | 772-589-2043
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Fax | 772-388-2628
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Provider Business Mailing Address
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Address Line | PO BOX 368
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City | ROSELAND
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State | FL
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Zip | 32957-0368
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Country | US
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Telephone | 772-589-2043
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Fax | 772-388-2628
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Authorized Official
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Title or Position | PRES
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Name | THERESA TOLLE
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Credential |
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Telephone | 772-589-2043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH8549
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License Number State | FL
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