Healthcare Provider Details

I. General information

NPI: 1093481145
Provider Name (Legal Business Name): NAOMI NIKOLE BAILEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 WATERFORD BLVD
EVANSVILLE IN
47715-2869
US

IV. Provider business mailing address

703 OKLAHOMA AVE
LINCOLN IL
62656-1846
US

V. Phone/Fax

Practice location:
  • Phone: 812-465-6202
  • Fax:
Mailing address:
  • Phone: 217-737-8552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2021030420
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: