Provider Demographics
NPI:1083691836
Name:BAYVIEW PLAZA PHARMACY INC
Entity Type:Organization
Organization Name:BAYVIEW PLAZA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:STREDLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:757-583-7466
Mailing Address - Street 1:7924 CHESAPEAKE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-3801
Mailing Address - Country:US
Mailing Address - Phone:757-583-7466
Mailing Address - Fax:
Practice Address - Street 1:7924 CHESAPEAKE BLVD STE A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-3801
Practice Address - Country:US
Practice Address - Phone:757-583-7466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201001900332B00000X
VAAB9807009333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0201001900OtherBOARD OF PHARMACY
VA009147446Medicaid
VA008513473Medicaid
VA4817409OtherNCPDP NUMBER
VAAB9807009OtherDEA NUMBER
VA0194060001Medicare NSC