1598158149 NPI number — BAYBRIDGE PHARMACY CORP

Table of content: (NPI 1598158149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598158149 NPI number — BAYBRIDGE PHARMACY CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYBRIDGE PHARMACY CORP
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:
BAYBRIDGE PHARMACY
Provider Other Organization Name Type Code:
3
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:
1598158149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20848 CROSS ISLAND PKWY
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
BAYSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11360-1187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-751-9911
Provider Business Mailing Address Fax Number:
718-751-9922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20848 CROSS ISLAND PKWY
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
BAYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11360-1187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-751-9911
Provider Business Practice Location Address Fax Number:
718-751-9922
Provider Enumeration Date:
03/06/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAVINO
Authorized Official First Name:
GREG
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERVISING PHARMACIST / OWNER
Authorized Official Telephone Number:
917-767-7647

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  033405 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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