Provider Demographics
NPI:1639652415
Name:BAY CITY RX LLC
Entity Type:Organization
Organization Name:BAY CITY RX LLC
Other - Org Name:ABBEY PHARMACY - BAY CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:3RD PARTY COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-751-7979
Mailing Address - Street 1:6689 ORCHARD LAKE RD # 168
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3404
Mailing Address - Country:US
Mailing Address - Phone:248-862-6148
Mailing Address - Fax:734-893-0006
Practice Address - Street 1:4 COLUMBUS AVE STE 145
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6457
Practice Address - Country:US
Practice Address - Phone:248-862-6148
Practice Address - Fax:734-893-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-08
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FSRX5865389OtherFLEXSCRIPT