Provider Demographics
NPI:1306156963
Name:B Y ENTERPRISES INC
Entity type:Organization
Organization Name:B Y ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:MERIDETH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:573-472-0608
Mailing Address - Street 1:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-0886
Mailing Address - Country:US
Mailing Address - Phone:573-475-1900
Mailing Address - Fax:573-472-1814
Practice Address - Street 1:808 HUNTER AVE STE 1A
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-2253
Practice Address - Country:US
Practice Address - Phone:573-475-1900
Practice Address - Fax:573-472-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO20100344983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO606493005Medicaid
2127022OtherPK