Bayside Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH31592 Issued in FL

Legal business name

BAYSIDE PHARMACY LLC

Practice address

205 1St St S Ste 106
Winter Haven, FL 33880-3266

Phone

(863) 377-4774

Fax

(863) 377-4744

NPI assigned

Aug 24, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Prof. Chiranjivi B Jannu, R.PH

Title

Director of Pharmacy

Phone

(646) 673-0044

Specialties & licenses 2

Addresses

Other names 1

• BUTTERFLY PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Tax ID family

Bayside Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bayside Pharmacy LLC

  • Long Term Care Pharmacy
  • Winter Haven, FL
  • NPI 1548835242
  NPD tax ID

Locations

Networks

• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Bayside Pharmacy LLC

  • Long Term Care Pharmacy
  • Winter Haven, FL
  • NPI 1548835242
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Agnus Commedore, PHARMD

  • Pharmacist
  • Tampa, FL
  • NPI 1275933897
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741737600000",
    "number": "1023599321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 1ST ST S STE 106",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338803266",
            "telephone_number": "863-377-4774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 1ST ST S STE 106",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338803266",
            "telephone_number": "863-377-4774",
            "fax_number": "863-377-4744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSIDE PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-24",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A",
        "authorized_official_last_name": "JANNU",
        "authorized_official_first_name": "CHIRANJIVI",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "DIRECTOR OF PHARMACY",
        "authorized_official_telephone_number": "646-673-0044",
        "authorized_official_name_prefix": "Prof.",
        "authorized_official_credential": "R.PH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH31592",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BUTTERFLY PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Baycare Medical Group Inc
• Baycare Medical Group, Inc
• Baycare Outpatient Imaging LLC
• Baycare Urgent Care, LLC
• Baycare Urgent Care, LLC
• Bayside Pharmacy LLC
• Jacqueline Bazemore
• Debra Dehass Beachy, FNP-BC
• Jessica Bearden, APRN
• Amy Beascoechea

• Community/Retail Pharmacy in Winter Haven, FL
• Providers in Winter Haven, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.