Provider Demographics
NPI:1407044035
Name:BAYLIFE PHARMACY INC
Entity Type:Organization
Organization Name:BAYLIFE PHARMACY INC
Other - Org Name:BAY LIFE PHARMACY I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONSULTANT, AO
Authorized Official - Prefix:
Authorized Official - First Name:NAZIR
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-692-9842
Mailing Address - Street 1:1235 S MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-9111
Mailing Address - Country:US
Mailing Address - Phone:727-581-5400
Mailing Address - Fax:787-581-5411
Practice Address - Street 1:1235 S MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-9111
Practice Address - Country:US
Practice Address - Phone:727-581-5400
Practice Address - Fax:787-581-5411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336S0011X
FLPH223953336L0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004617900Medicaid
2009835OtherPK