=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407963242
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LOIS ANN BAILEY MD, RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2006
-----------------------------------------------------
Last Update Date | 11/21/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6119 HORSESHOE BAR RD
-----------------------------------------------------
City | LOOMIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95650-8528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-652-5633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1575
-----------------------------------------------------
City | LOOMIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95650-1575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-652-5633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH55263
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS39116
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 14393
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 10189
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PH2450
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | G54816
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------