Provider Demographics
NPI:1285716076
Name:BAY PHARMACY INC
Entity type:Organization
Organization Name:BAY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUDREAU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:906-643-7725
Mailing Address - Street 1:112 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNACE
Mailing Address - State:MI
Mailing Address - Zip Code:49781-1618
Mailing Address - Country:US
Mailing Address - Phone:906-643-7725
Mailing Address - Fax:906-643-6345
Practice Address - Street 1:112 S STATE ST
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-1618
Practice Address - Country:US
Practice Address - Phone:906-643-7725
Practice Address - Fax:906-643-6345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010038223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2043195OtherPK
MI2542983Medicaid