Mack Bayou Pharmacy LLC

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

PH26321 Issued in FL

Legal business name

MACK BAYOU PHARMACY LLC

Doing business as

Mack Bayou Pharmacy LLC

Practice address

82 Mack Bayou Loop Ste B
Santa Rosa Beach, FL 32459-2607

Phone

(850) 622-0730

Fax

(850) 622-0755

NPI assigned

Jul 24, 2012

Last updated

Mar 1, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amy Frazier, PHARMD

Title

Owner

Phone

(850) 622-0730

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Mack Bayou Pharmacy LLC Doing business as

Locations

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

{
    "created_epoch": "1343088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488326400000",
    "number": "1508112889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 MACK BAYOU LOOP STE B",
            "city": "SANTA ROSA BEACH",
            "state": "FL",
            "postal_code": "324592607",
            "telephone_number": "850-622-0730",
            "fax_number": "850-622-0755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 MACK BAYOU LOOP STE B",
            "city": "SANTA ROSA BEACH",
            "state": "FL",
            "postal_code": "324592607",
            "telephone_number": "850-622-0730",
            "fax_number": "850-622-0755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACK BAYOU PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-24",
        "last_updated": "2017-03-01",
        "status": "A",
        "authorized_official_last_name": "FRAZIER",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-622-0730",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "FL",
            "license": "PH26321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2137562",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mack Bayou Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Compounding Pharmacy in Santa Rosa Beach, FL
• Providers in Santa Rosa Beach, FL by specialty
• Compounding Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.