=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992000830
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAY DRUG, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2011
-----------------------------------------------------
Last Update Date | 01/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 281 TURK ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94102-3807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-400-5999
-----------------------------------------------------
Fax | 415-400-5998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25379 WAYNE MILLS PL # 300
-----------------------------------------------------
City | VALENCIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91355-1827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-294-9411
-----------------------------------------------------
Fax | 661-294-9452
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. GAETANO JAMES FORTE
-----------------------------------------------------
Credential | RPH.
-----------------------------------------------------
Telephone | 206-353-1425
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------