Provider Demographics
NPI:1790273944
Name:HARBOUR BAY PHARMACY LLC
Entity Type:Organization
Organization Name:HARBOUR BAY PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:YUN
Authorized Official - Last Name:YUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-757-3793
Mailing Address - Street 1:3754 SE OCEAN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-6700
Mailing Address - Country:US
Mailing Address - Phone:844-407-3681
Mailing Address - Fax:561-529-3117
Practice Address - Street 1:3754 SE OCEAN BLVD STE B
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996
Practice Address - Country:US
Practice Address - Phone:844-407-3681
Practice Address - Fax:561-529-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177002OtherPK