Provider Demographics
NPI:1821326919
Name:BAYRX LLC
Entity Type:Organization
Organization Name:BAYRX LLC
Other - Org Name:MIKE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / VP
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLUNOVA
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:510-532-1002
Mailing Address - Street 1:2700 INTERNATIONAL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1555
Mailing Address - Country:US
Mailing Address - Phone:510-532-1002
Mailing Address - Fax:515-532-1011
Practice Address - Street 1:2700 INTERNATIONAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1555
Practice Address - Country:US
Practice Address - Phone:510-532-1002
Practice Address - Fax:515-532-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY50028333600000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5636519OtherNCPDP PROVIDER IDENTIFICATION NUMBER