Provider Demographics
NPI:1457530040
Name:ORANGE-BAY PHARMACY LLC
Entity Type:Organization
Organization Name:ORANGE-BAY PHARMACY LLC
Other - Org Name:ORANGE BAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANRE
Authorized Official - Middle Name:
Authorized Official - Last Name:OKUSANYA
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:412-996-2266
Mailing Address - Street 1:4625 N NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-4013
Mailing Address - Country:US
Mailing Address - Phone:813-418-6780
Mailing Address - Fax:813-238-0237
Practice Address - Street 1:4625 N NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-4013
Practice Address - Country:US
Practice Address - Phone:813-418-6780
Practice Address - Fax:813-238-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH234003336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL426700Medicaid
2005573OtherPK