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Organization
BAYSIDE RX LLC
Active
Organization
BAYSIDE RX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACLYN PRISCO (PRESIDENT)
(646) 806-6480
Entity
Organization
Contact information
Practice address
21411 41ST AVE, FLUSHING, NY 11361-2133
(718) 244-1400
(718) 244-1444
Mailing address
21411 41ST AVE, FLUSHING, NY 11361-2133
(718) 244-1400
(718) 244-1444
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
NULL
3336C0003X
Community/Retail Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2166345
PK
—
Enumeration date
04/06/2016
Last updated
01/20/2017
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