Organization
BAYGREEN PHARMACY CORP
Active
Other names
Baygreen Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
PARUL MAMTORA (DIRECTOR)
(904) 535-7514
Entity
Organization
Contact information
Practice address
9860 BEACH BLVD STE C, JACKSONVILLE, FL 32246-4704
(904) 201-8222
(904) 297-4039
Mailing address
PO BOX 600316, JACKSONVILLE, FL 32260-0316
(904) 201-8222
(904) 297-4039
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH25960
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005613900
—
FL
01
—
2133954
PK
—
Enumeration date
02/24/2012
Last updated
09/19/2022
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