Provider Demographics
NPI:1265921613
Name:BAZE PHARMACY LLC
Entity type:Organization
Organization Name:BAZE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATHELIA
Authorized Official - Middle Name:BALAMS
Authorized Official - Last Name:EZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-323-5033
Mailing Address - Street 1:900 STARK RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-3613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 STARK RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3613
Practice Address - Country:US
Practice Address - Phone:662-323-5033
Practice Address - Fax:662-323-5053
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAZE PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty