Provider Demographics
NPI:1104452861
Name:BAYSIDE DRUGS INC
Entity type:Organization
Organization Name:BAYSIDE DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDURAKHMANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-224-7300
Mailing Address - Street 1:3801 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2058
Mailing Address - Country:US
Mailing Address - Phone:718-224-7300
Mailing Address - Fax:718-224-7306
Practice Address - Street 1:3801 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2058
Practice Address - Country:US
Practice Address - Phone:718-224-7300
Practice Address - Fax:718-224-7306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy