Provider Demographics
NPI:1295145605
Name:BAYSHORE HEALTH MART, INC.
Entity type:Organization
Organization Name:BAYSHORE HEALTH MART, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PIYUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:MESURIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-322-9746
Mailing Address - Street 1:3315 BURKE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1873
Mailing Address - Country:US
Mailing Address - Phone:281-984-5000
Mailing Address - Fax:
Practice Address - Street 1:3315 BURKE RD STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1873
Practice Address - Country:US
Practice Address - Phone:833-322-9746
Practice Address - Fax:833-322-9746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX290253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145543OtherPK
TX148355Medicaid