1518442771 NPI number — BAY PHARMACIES INC

Table of content: (NPI 1518442771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518442771 NPI number — BAY PHARMACIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY PHARMACIES INC
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:
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:
1518442771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 EGG HARBOR RD STE 112
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STURGEON BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54235-1248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-746-2158
Provider Business Mailing Address Fax Number:
920-746-2138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1717 E CALUMET ST UNIT C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLETON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54915-4079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-746-2158
Provider Business Practice Location Address Fax Number:
920-746-2138
Provider Enumeration Date:
10/03/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HAGEN
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/COO
Authorized Official Telephone Number:
920-746-2158

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100075677 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com