Organization · NPI-2

Bayshore Pharmacy

Pharmacy, Community/Retail Pharmacy · Port Saint Lucie, FL

NPI number1750723722

StatusActive

Last updated in NPPESMar 9, 2017

Details

NPI: 1750723722
Entity type: Organization (NPI-2)
Legal business name: Bayshore Pharmacy
Organization subpart: No
Enumeration date: Jul 19, 2013
Last updated: Mar 9, 2017

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
3336C0003X	Pharmacy, Community/Retail Pharmacy	PH26774	FL	Yes
332B00000X	Durable Medical Equipment & Medical Supplies	–	–
333600000X	Pharmacy	–	–
3336C0004X	Pharmacy, Compounding Pharmacy	–	–

Other names

Bayshore Pharmacy (Doing Business As)

Practice location

1026 Sw Bayshore Blvd
Port Saint Lucie, FL 34983-2400

Phone 772-344-0410 · Fax 772-344-0409

Mailing address

1026 Sw Bayshore Blvd
Port Saint Lucie, FL 34983-2400

Phone 772-344-0410 · Fax 772-344-0409

Authorized official

Keith Serrago
Pharmacist/Chief
7723440410

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