Provider Demographics
NPI:1316033434
Name:BOB BAY & SON CO INC
Entity Type:Organization
Organization Name:BOB BAY & SON CO INC
Other - Org Name:CARNIVAL FOODS PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-687-9433
Mailing Address - Street 1:1215 N MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1626
Mailing Address - Country:US
Mailing Address - Phone:740-687-1130
Mailing Address - Fax:740-652-2604
Practice Address - Street 1:1215 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1626
Practice Address - Country:US
Practice Address - Phone:740-687-1130
Practice Address - Fax:740-652-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-1366950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2390461Medicaid
OH5437510001Medicare ID - Type Unspecified