Provider Demographics
NPI:1841294469
Name:BAY PHARMACY, INC
Entity type:Organization
Organization Name:BAY PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:228-466-9333
Mailing Address - Street 1:308 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-3532
Mailing Address - Country:US
Mailing Address - Phone:228-466-9333
Mailing Address - Fax:228-466-9330
Practice Address - Street 1:308 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-3532
Practice Address - Country:US
Practice Address - Phone:228-466-9333
Practice Address - Fax:228-466-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS037570113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS4654050001Medicare NSC