Provider Demographics
NPI:1073877437
Name:BAYARD PHARMACY LLC
Entity Type:Organization
Organization Name:BAYARD PHARMACY LLC
Other - Org Name:BAYARD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:MABUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-632-5149
Mailing Address - Street 1:202 W LOOCKERMAN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3248
Mailing Address - Country:US
Mailing Address - Phone:302-724-4497
Mailing Address - Fax:302-526-4835
Practice Address - Street 1:202 W LOOCKERMAN ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3248
Practice Address - Country:US
Practice Address - Phone:302-724-4497
Practice Address - Fax:302-526-4835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-01
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
DEA3-00009443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135897OtherPK
DE6745100001Medicare NSC