Provider Demographics
NPI:1891211256
Name:BAYLIFE PHARMACY INC
Entity Type:Organization
Organization Name:BAYLIFE PHARMACY INC
Other - Org Name:BAY LIFE PHARMACY I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-254-2037
Mailing Address - Street 1:1235 S MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-9111
Mailing Address - Country:US
Mailing Address - Phone:727-581-5400
Mailing Address - Fax:727-581-5411
Practice Address - Street 1:1235 S MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-9111
Practice Address - Country:US
Practice Address - Phone:727-581-5400
Practice Address - Fax:727-581-5411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH223953336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004617900Medicaid