Healthcare Provider Details

I. General information

NPI: 1982952602
Provider Name (Legal Business Name): HEATHER LYNN BAILEY PHARMD, MSCR, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W. 5TH AVE
NOME AK
99762-7123
US

IV. Provider business mailing address

183 CEDAR CIR
POWELL TN
37849-7123
US

V. Phone/Fax

Practice location:
  • Phone: 907-443-3311
  • Fax:
Mailing address:
  • Phone: 865-591-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2114
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22737
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: