Provider Demographics
NPI:1578661088
Name:BAYSIDE DRUGS INC
Entity Type:Organization
Organization Name:BAYSIDE DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:727-595-9402
Mailing Address - Street 1:12071 INDIAN ROCKS RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774
Mailing Address - Country:US
Mailing Address - Phone:727-595-9402
Mailing Address - Fax:727-595-2081
Practice Address - Street 1:12071 INDIAN ROCKS RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774
Practice Address - Country:US
Practice Address - Phone:727-595-9402
Practice Address - Fax:727-595-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH17923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1045031OtherNABP
1045031OtherNABP