1336420280 NPI number — BAYHEALTH MEDICAL CENTER DBA BAYHEALTH COMMUNITY PHARMACY KENT

Table of content: (NPI 1336420280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336420280 NPI number — BAYHEALTH MEDICAL CENTER DBA BAYHEALTH COMMUNITY PHARMACY KENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYHEALTH MEDICAL CENTER DBA BAYHEALTH COMMUNITY PHARMACY KENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336420280
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BAYHEALTH COMMUNITY PHARMACY-KENT
Provider Second Line Business Mailing Address:
640 S. STATE STREET
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-744-6616
Provider Business Mailing Address Fax Number:
302-744-6620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BAYHEALTH COMMUNITY PHARMACY-KENT
Provider Second Line Business Practice Location Address:
640 S. STATE STREET
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-744-6616
Provider Business Practice Location Address Fax Number:
302-744-6620
Provider Enumeration Date:
09/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BYRNE
Authorized Official First Name:
MADELINE
Authorized Official Middle Name:
MARY
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
302-744-6617

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  A30000890 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1467546135 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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