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General NPI Number Information
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NPI Number | 1902170889
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Entity Type | Organization
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Legal Business Name | BAYGREEN PHARMACY CORP
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 9860 BEACH BLVD STE C
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City | JACKSONVILLE
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State | FL
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Zip | 32246-4704
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Country | US
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Telephone | 904-201-8222
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Fax | 904-297-4039
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Provider Business Mailing Address
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Address Line | PO BOX 600316
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City | JACKSONVILLE
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State | FL
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Zip | 32260-0316
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Country | US
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Telephone | 904-201-8222
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Fax | 904-297-4039
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Authorized Official
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Title or Position | DIRECTOR
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Name | PARUL MAMTORA
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Credential |
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Telephone | 904-535-7514
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH25960
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License Number State | FL
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