Provider Demographics
NPI:1598158149
Name:BAYBRIDGE PHARMACY CORP
Entity Type:Organization
Organization Name:BAYBRIDGE PHARMACY CORP
Other - Org Name:BAYBRIDGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:917-767-7647
Mailing Address - Street 1:20848 CROSS ISLAND PKWY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1187
Mailing Address - Country:US
Mailing Address - Phone:718-751-9911
Mailing Address - Fax:718-751-9922
Practice Address - Street 1:20848 CROSS ISLAND PKWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1187
Practice Address - Country:US
Practice Address - Phone:718-751-9911
Practice Address - Fax:718-751-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0334053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7351500001Medicare NSC