Provider Demographics
NPI:1518442771
Name:BAY PHARMACIES INC
Entity Type:Organization
Organization Name:BAY PHARMACIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-746-2158
Mailing Address - Street 1:1300 EGG HARBOR RD STE 112
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1248
Mailing Address - Country:US
Mailing Address - Phone:920-746-2158
Mailing Address - Fax:920-746-2138
Practice Address - Street 1:1717 E CALUMET ST UNIT C
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-4079
Practice Address - Country:US
Practice Address - Phone:920-746-2158
Practice Address - Fax:920-746-2138
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAY PHARMACIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100075677Medicaid