Provider Demographics
NPI:1508385337
Name:BAYONNE PHARMACY INC
Entity Type:Organization
Organization Name:BAYONNE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BOLOGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-304-1854
Mailing Address - Street 1:455 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-7112
Mailing Address - Country:US
Mailing Address - Phone:201-339-1992
Mailing Address - Fax:201-858-1714
Practice Address - Street 1:455 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-7112
Practice Address - Country:US
Practice Address - Phone:201-339-1992
Practice Address - Fax:201-858-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7195613Medicaid