Organization
BAYSIDE LAKES PHARMACY LLC
Active
Other names
Bayside Lakes Family Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN ELIZABETH MACDONALD (OWNER)
(321) 308-0303
Entity
Organization
Contact information
Practice address
1850 ELDRON BLVD SE STE 7, PALM BAY, FL 32909-6870
(321) 308-0303
(321) 308-0310
Mailing address
1850 ELDRON BLVD SE, PALM BAY, FL 32909-6870
(321) 308-0303
(321) 308-0310
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH31554
FL
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100868600
—
FL
01
—
PH31554
BOARD OF PHARMACY
FL
Enumeration date
07/25/2018
Last updated
12/21/2018
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