Provider Demographics
NPI:1295829638
Name:BAY PHARMACY, INC.
Entity Type:Organization
Organization Name:BAY PHARMACY, INC.
Other - Org Name:LAKE PHARMACY- TAVARES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:352-357-4341
Mailing Address - Street 1:2 E MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-3417
Mailing Address - Country:US
Mailing Address - Phone:352-357-4341
Mailing Address - Fax:352-357-5107
Practice Address - Street 1:2 E MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3417
Practice Address - Country:US
Practice Address - Phone:352-357-4341
Practice Address - Fax:352-357-5107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 157953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1082572OtherNCPDP
FL106292100Medicaid
FL106292100Medicaid