Provider Demographics
NPI:1639210362
Name:BAY PHARMACIES INC
Entity Type:Organization
Organization Name:BAY PHARMACIES INC
Other - Org Name:BAY PHARMACY HEALTH MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:
Authorized Official - First Name:TANAPONG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAIRIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:920-746-2977
Mailing Address - Street 1:1300 EGG HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1277
Mailing Address - Country:US
Mailing Address - Phone:920-746-2977
Mailing Address - Fax:920-746-2968
Practice Address - Street 1:1300 EGG HARBOR RD
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-1277
Practice Address - Country:US
Practice Address - Phone:920-746-2977
Practice Address - Fax:920-746-2968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
WI6547-0423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2114324OtherPK
WI33127300Medicaid
2114324OtherPK