Healthcare Provider Details

I. General information

NPI: 1306511167
Provider Name (Legal Business Name): ISAAC R BAILEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W COWLES ST
FAIRBANKS AK
99701-5926
US

IV. Provider business mailing address

1369 N BECKER RIDGE RD
FAIRBANKS AK
99709-2802
US

V. Phone/Fax

Practice location:
  • Phone: 907-459-3807
  • Fax: 907-459-3910
Mailing address:
  • Phone: 907-378-7909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number178994
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: