Baygreen Pharmacy Corp

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH25960 Issued in FL

Legal business name

BAYGREEN PHARMACY CORP

Practice address

9860 Beach Blvd Ste C
Jacksonville, FL 32246-4704

Phone

(904) 201-8222

Fax

(904) 297-4039

NPI assigned

Feb 24, 2012

Organization subpart

No

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

Authorized official

Name

Parul Mamtora

Title

Director

Phone

(904) 535-7514

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Baygreen Pharmacy Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Judy Kommareddy, PHARM D

  • Pharmacist
  • Jacksonville, FL
  • NPI 1538290044
  NPD

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

{
    "created_epoch": "1330041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663545600000",
    "number": "1902170889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 600316",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322600316",
            "telephone_number": "904-201-8222",
            "fax_number": "904-297-4039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9860 BEACH BLVD STE C",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322464704",
            "telephone_number": "904-201-8222",
            "fax_number": "904-297-4039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYGREEN PHARMACY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-24",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A",
        "authorized_official_last_name": "MAMTORA",
        "authorized_official_first_name": "PARUL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "904-535-7514"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH25960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005613900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2133954",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baygreen Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Baygreen Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Jacksonville, FL
• Providers in Jacksonville, 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 Sep 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.