Provider Demographics
NPI:1497001499
Name:BYPASS PHARMACY INC
Entity Type:Organization
Organization Name:BYPASS PHARMACY INC
Other - Org Name:BYPASS PHARMACY # 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIDDARTHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ILANGOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-222-3064
Mailing Address - Street 1:104 S EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4930
Mailing Address - Country:US
Mailing Address - Phone:304-222-3064
Mailing Address - Fax:304-253-3982
Practice Address - Street 1:725 RITTER DR FL 1
Practice Address - Street 2:
Practice Address - City:GLEN MORGAN
Practice Address - State:WV
Practice Address - Zip Code:25813-7709
Practice Address - Country:US
Practice Address - Phone:304-252-3000
Practice Address - Fax:304-252-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
WVSP05524333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136181OtherPK
5055682OtherNCPDP PROVIDER IDENTIFICATION NUMBER
WV6651630002Medicare NSC