MEDICARE: BAYARD L C PHARMACY CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205979721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYARD L C PHARMACY CORP

Provider Business Mailing Address
First Line	:	62 BAYARD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-4938
Country	:	US
Telephone Number	:	212-219-8116
Fax Number	:	212-219-8115

Provider Business Practice Location Address
First Line	:	62 BAYARD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-4938
Country	:	US
Telephone Number	:	212-219-8116
Fax Number	:	212-219-8115

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIAN XIA CHEN
Credential	:
Telephone Number	:	212-219-8116

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	09/26/2025

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