Provider Demographics
NPI:1932565793
Name:BAYVIEW DISCOUNT PHARMACY
Entity Type:Organization
Organization Name:BAYVIEW DISCOUNT PHARMACY
Other - Org Name:BAYVIEW SRC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADI
Authorized Official - Middle Name:
Authorized Official - Last Name:GELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-819-4636
Mailing Address - Street 1:710 E LITTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-3710
Mailing Address - Country:US
Mailing Address - Phone:757-819-4636
Mailing Address - Fax:757-333-7264
Practice Address - Street 1:710 E LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-3710
Practice Address - Country:US
Practice Address - Phone:757-819-4636
Practice Address - Fax:757-333-7264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010046853336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157333OtherPK