Provider Demographics
NPI:1336420280
Name:BAYHEALTH MEDICAL CENTER DBA BAYHEALTH COMMUNITY PHARMACY KENT
Entity type:Organization
Organization Name:BAYHEALTH MEDICAL CENTER DBA BAYHEALTH COMMUNITY PHARMACY KENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:302-744-6617
Mailing Address - Street 1:BAYHEALTH COMMUNITY PHARMACY-KENT
Mailing Address - Street 2:640 S. STATE STREET
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901
Mailing Address - Country:US
Mailing Address - Phone:302-744-6616
Mailing Address - Fax:302-744-6620
Practice Address - Street 1:BAYHEALTH COMMUNITY PHARMACY-KENT
Practice Address - Street 2:640 S. STATE STREET
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901
Practice Address - Country:US
Practice Address - Phone:302-744-6616
Practice Address - Fax:302-744-6620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA300008903336C0002X
3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1467546135Medicaid