Bayshore Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH26774 Issued in FL

Legal business name

BAYSHORE PHARMACY

Practice address

1026 SW Bayshore Blvd
Port Saint Lucie, FL 34983-2400

Phone

(772) 344-0410

Fax

(772) 344-0409

NPI assigned

Jul 19, 2013

Organization subpart

No

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

Authorized official

Name

Keith SerragoNPI 1811022684

Title

Pharmacist/Chief

Phone

(772) 344-0410

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Bayshore Pharmacy Doing business as

Locations

Practitioners 1

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

• Keith Richard Serrago, RPH,PHARMD,CPH

  • Pharmacist
  • Port St Lucie, FL
  • NPI 1811022684
  NPD (past) Authorized official

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

{
    "created_epoch": "1374192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489017600000",
    "number": "1750723722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1026 SW BAYSHORE BLVD",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349832400",
            "telephone_number": "772-344-0410",
            "fax_number": "772-344-0409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1026 SW BAYSHORE BLVD",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349832400",
            "telephone_number": "772-344-0410",
            "fax_number": "772-344-0409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSHORE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-19",
        "last_updated": "2017-03-09",
        "status": "A",
        "authorized_official_last_name": "SERRAGO",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "PHARMACIST/CHIEF",
        "authorized_official_telephone_number": "772-344-0410"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH26774",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101097200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2140977",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bayshore Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deidra Bass
• Britney D Bates, LAT/ATC
• Yomaris Patricia Bauza-Rodriguez, FNP-C
• Christina Lynne Baxter
• Bayamo Assisted Living
• Bayshore Residence Alf
• Breeyon Beachel, PA-C
• Vanessa Beaubrun, RN
• Pierre Beauge, RN
• Bridgette Beaumont

• Community/Retail Pharmacy in Port Saint Lucie, FL
• Providers in Port Saint Lucie, 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 9, 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.