Provider Demographics
NPI:1962792531
Name:BAYFRONT HMA MEDICAL CENTER PHARMACY
Entity type:Organization
Organization Name:BAYFRONT HMA MEDICAL CENTER PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH MBA
Authorized Official - Phone:727-893-6132
Mailing Address - Street 1:701 6TH ST. S.
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4891
Mailing Address - Country:US
Mailing Address - Phone:727-893-6334
Mailing Address - Fax:727-893-6337
Practice Address - Street 1:701 6TH ST. S.
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4891
Practice Address - Country:US
Practice Address - Phone:727-893-6132
Practice Address - Fax:727-893-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH82403336C0003X
FLPH268993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5705364OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL004416000Medicaid