MEDICARE: BRIANNA GRACE BAILEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03439917	OH

General Provider Information

NPI Number	:	1205440716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA GRACE BAILEY

Provider Business Mailing Address
First Line	:	11734 NEW BUFFALO RD
Second Line	:
City	:	NORTH LIMA
State	:	OH
Zip	:	44452-9733
Country	:	US
Telephone Number	:	330-303-7370
Fax Number	:

Provider Business Practice Location Address
First Line	:	4914 YOUNGSTOWN POLAND RD
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44514-1152
Country	:	US
Telephone Number	:	330-755-2421
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	09/02/2020

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Directions to “ BRIANNA GRACE BAILEY ” Practice Location

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