Provider Demographics
NPI:1861452377
Name:BAYVIEW PLAZA PHARMACY, INC.
Entity Type:Organization
Organization Name:BAYVIEW PLAZA PHARMACY, INC.
Other - Org Name:MERCURY WEST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-827-1938
Mailing Address - Street 1:7924 CHESAPEAKE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-3801
Mailing Address - Country:US
Mailing Address - Phone:757-583-7466
Mailing Address - Fax:
Practice Address - Street 1:2268 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2430
Practice Address - Country:US
Practice Address - Phone:757-827-1938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201002118333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008514208Medicaid
VA4818172OtherNABP
VA010246491Medicaid
VA010246491Medicaid
VA0194060002Medicare NSC