Provider Demographics
NPI:1760793772
Name:BYPASS PHARMACY, INC
Entity Type:Organization
Organization Name:BYPASS PHARMACY, INC
Other - Org Name:BYPASS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIDDARTHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ILANGOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-222-3064
Mailing Address - Street 1:104 S EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4930
Mailing Address - Country:US
Mailing Address - Phone:304-256-2006
Mailing Address - Fax:304-860-1968
Practice Address - Street 1:104 S EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4930
Practice Address - Country:US
Practice Address - Phone:304-256-2006
Practice Address - Fax:304-860-1968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WVSP05524073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5055252OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5055252OtherNCPDP PROVIDER IDENTIFICATION NUMBER