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MACK BAYOU PHARMACY LLC NPI 1508112889


NPI Information

NPI: 1508112889
Provider Name: MACK BAYOU PHARMACY LLC

Doing Business As: MACK BAYOU PHARMACY LLC

Classification: Pharmacy - 3336C0004X
Entity Type: Organization

Specialization: Compounding Pharmacy

Address:
82 MACK BAYOU LOOP STE B
SANTA ROSA BEACH, FL
ZIP 32459
Phone: (850) 622-0730
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MACK BAYOU PHARMACY LLC is a compounding pharmacy pharmacy in Santa Rosa Beach, FL. The provider is a pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner's Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice. MACK BAYOU PHARMACY LLC NPI is 1508112889. The provider is registered as an organization entity type.
The provider Is Doing Business As Mack Bayou Pharmacy Llc.

The provider's business location address is:

82 MACK BAYOU LOOP STE B
SANTA ROSA BEACH, FL
ZIP 32459-607
Phone: (850) 622-0730
Fax: (850) 622-0755

The provider's authorized official is Amy Frazier .
The authorized official title is Owner and has the following contact phone number (850) 622-0730.

The enumeration date for this NPI number is 7/24/2012 and was last updated on 3/1/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
13336C0003XPharmacyCommunity/Retail PharmacyNo
2333600000XPharmacyNo
33336C0004XPharmacyCompounding PharmacyPH26321FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
12137562OTHERPK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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