Healthcare Provider Details

I. General information

NPI: 1073919403
Provider Name (Legal Business Name): JONN BAILEY PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5640 READ BLVD
NEW ORLEANS LA
70127-3140
US

IV. Provider business mailing address

1 DREXEL DR BOX COLLEGE OF PHARMACY
NEW ORLEANS LA
70125-1056
US

V. Phone/Fax

Practice location:
  • Phone: 504-248-5357
  • Fax:
Mailing address:
  • Phone: 504-520-5339
  • Fax: 504-520-7971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number020557
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number448188
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: