Healthcare Provider Details

I. General information

NPI: 1316668528
Provider Name (Legal Business Name): BAILEE ESCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 COURTRIGHT RD
MARTIN TN
38237-1606
US

IV. Provider business mailing address

207 MILL ST
GLEASON TN
38229-7435
US

V. Phone/Fax

Practice location:
  • Phone: 731-587-3819
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46306
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: