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Organization
MACK BAYOU PHARMACY LLC
Active
Organization
MACK BAYOU PHARMACY LLC
Active
Other names
Mack Bayou Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
AMY FRAZIER PHARMD (OWNER)
(850) 622-0730
Entity
Organization
Contact information
Practice address
82 MACK BAYOU LOOP STE B, SANTA ROSA BEACH, FL 32459-2607
(850) 622-0730
(850) 622-0755
Mailing address
82 MACK BAYOU LOOP STE B, SANTA ROSA BEACH, FL 32459-2607
(850) 622-0730
(850) 622-0755
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
Primary
PH26321
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137562
PK
—
Enumeration date
07/24/2012
Last updated
03/01/2017
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