Provider Demographics
NPI:1942365366
Name:BAYVILLE PHARMACY INC
Entity Type:Organization
Organization Name:BAYVILLE PHARMACY INC
Other - Org Name:BAYVILLE PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAMPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-628-3640
Mailing Address - Street 1:253 BAYVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-1670
Mailing Address - Country:US
Mailing Address - Phone:516-628-3640
Mailing Address - Fax:516-628-3657
Practice Address - Street 1:253 BAYVILLE AVE
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11709-1670
Practice Address - Country:US
Practice Address - Phone:516-628-3640
Practice Address - Fax:516-628-3657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0180833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2062054OtherPK
NY00822362Medicaid