MACK BAYOU PHARMACY LLC (NPI# 1508112889) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508112889 |
| Entity Type | Organization |
| Organization Name | MACK BAYOU PHARMACY LLC |
| Other Organization Name | MACK BAYOU PHARMACY LLC |
| Practice Address |
82 Mack Bayou Loop Ste B Santa Rosa Beach FL 32459-2607 |
| Practice Telephone | 8506220730 |
| Practice Fax Number | 8506220755 |
| Mailing Telephone | 8506220730 |
| Mailing Fax Number | 8506220755 |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2017-03-01 |
| Authorized Official Name | AMY FRAZIER (OWNER) |
| Authorized Official Telephone | 8506220730 |
| Authorized Official Credential | PHARMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
PH26321 | FL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2137562 | 01 |
| Other Name | Type Code |
|---|---|
| Mack Bayou Pharmacy LLC | Doing Business As Name - Organization |
| Street Address |
82 MACK BAYOU LOOP STE B |
| City | SANTA ROSA BEACH |
| State | FL |
| Zip Code | 32459-2607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336740521 | Gary Mcfadyen | Hearing Instrument Specialist | 395 E. Point Washington, Santa Rosa Beach, FL 32459 | 2020-11-04 |
| 1235783218 | Camilla Ruth Chacon | Nurse Practitioner | 4821 Highway 98 West, Suite 104, Santa Rosa Beach, FL 32459 | 2019-07-29 |
| 1942797287 | Lauren Mank | Assistant Behavior Analyst | 67 Hiker St Fl 32459, Santa Rosa Beach, FL 32459 | 2018-04-20 |
| 1740781137 | Imaging Institute LLC | Radiology | 6757 Us Hwy 98 W Ste 301, Santa Rosa Beach, FL 32459 | 2018-02-22 |
| 1023540648 | Emerald Coast Medical Supplies LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 48 Bald Eagle Dr, Santa Rosa Beach, FL 32459 | 2017-04-02 |
| 1215485230 | Tamra Snook | Social Worker | 156 N County Highway 393 Unit 1, Santa Rosa Beach, FL 32459 | 2016-09-19 |
| 1437605730 | Alexandra Armstrong | Physical Therapist | 249 Mack Bayou Loop Ste 101, Santa Rosa Beach, FL 32459 | 2016-08-28 |
| 1386097749 | Itetra Smith | Behavior Technician | 67 Hiker St, Santa Rosa Beach, FL 32459 | 2016-07-20 |
| 1730527086 | Emerald Coast Medical Supplies LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 48 Bald Eagle Drive, Santa Rosa Beach, FL 32459 | 2013-06-10 |
| 1114269768 | Pamela Jean Skaff | Dentist | 101 Lecom Way, Defuniak Springs, FL 32459 | 2013-03-21 |
| Find all providers in zip 32459 | ||||
| Taxonomy Code | 3336C0004X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Compounding Pharmacy |
| 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. |
| Notes: Sources: NABP Model Practice Act, Appendix C - Good Compounding Practice, USP <795> and <797>, and Pharmacy Compounding Accreditation Board [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881900074 | Emerald Coast Compounding Pharmacy | Pharmacy | 7 Town Center Loop, Unit C-15, Santa Rosa Beach, FL 32459-8736 | 2010-08-25 |
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|---|---|---|---|---|
| 1508473414 | Tu Te Wellness Pharmacy LLC | Pharmacy | 8563 Argyle Business Loop Ste 1, Jacksonville, FL 32244-6613 | 2020-09-24 |
| 1467068197 | Avm Compounding Pharmacy LLC | Pharmacy | 501 S Lincoln Ave Ste 203, Clearwater, FL 33756-5945 | 2020-09-18 |
| 1376151423 | 1st America Infusion Services LLC | Pharmacy | 639 N Highway 231, Panama City, FL 32405-4704 | 2020-07-15 |
| 1114540416 | Ramzy's Mediterranean Cafe Pharmacy, Inc | Pharmacy | 8740 N Kendall Dr Ste 106, Miami, FL 33176-2209 | 2020-05-20 |
| 1023643707 | Ops International Incorporated | Pharmacy | 4600 L B Mcleod Rd, Orlando, FL 32811-6454 | 2020-03-03 |
| 1639709454 | Medstop | Pharmacy | 2095 W Fairbanks Ave, Winter Park, FL 32789-4543 | 2020-01-21 |
| 1922644491 | My Prescription Coach, LLC | Pharmacy | 5008 W. Linebaugh Avenue, Suites 33 &34, Tampa, FL 33624-5038 | 2019-11-20 |
| 1346709540 | Pharmacygo, Inc | Pharmacy | 20041 S Tamiami Trl Ste 13, Estero, FL 33928-2228 | 2019-03-18 |
| 1124596150 | Rx for All Pharmacy Corp | Pharmacy | 1325 Nw 93rd Ct Ste B109, Doral, FL 33172-2835 | 2018-11-07 |
| 1710472451 | Caring Rx, LLC | Pharmacy | 21002 S Ridgewood Ave, Suite 2, Edgewater, FL 32141 | 2018-06-26 |
| Find all providers with the same taxonomy | ||||
| City | SANTA ROSA BEACH |
| Zip Code | 32459 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.