Healthcare Provider Details

I. General information

NPI: 1710462437
Provider Name (Legal Business Name): EMILY BROOKE BAILEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18591 N 59TH AVE
GLENDALE AZ
85308-1251
US

IV. Provider business mailing address

1 CVS DR
WOONSOCKET RI
02895-6146
US

V. Phone/Fax

Practice location:
  • Phone: 602-789-1166
  • Fax:
Mailing address:
  • Phone: 800-746-7287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS023450
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: