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NPI Code Detail

MEDICARE: ELISABETH JOHNSON BAILEY RPH

MEDICARE: ELISABETH JOHNSON BAILEY RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistRPH018859GA
2183500000XPharmacist8882SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RPH018859OTHERGAPHARMACY LICENSE NUMBER FOR THE STATE OF GEORGIA

General Provider Information

NPI Number : 1255742136
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISABETH JOHNSON BAILEY RPH
Provider Business Mailing Address
First Line : 2818 WICKEFORD MILL DR
Second Line :
City : BUFORD
State : GA
Zip : 30519-7611
Country : US
Telephone Number : 678-622-3766
Fax Number :
Provider Business Practice Location Address
First Line : 400 SHALLOWFORD RD NW
Second Line :
City : GAINESVILLE
State : GA
Zip : 30504-4152
Country : US
Telephone Number : 770-531-0325
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2014
Last Update Date : 05/14/2014

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