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NPI Code Detail

MEDICARE: MR. VICTOR GLENN BAILEY JR. PHARMACIST

MEDICARE:  MR. VICTOR GLENN BAILEY JR. PHARMACIST
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
1183500000XPharmacistE08802MS

General Provider Information

NPI Number : 1265556518
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. VICTOR GLENN BAILEY JR. PHARMACIST
Provider Business Mailing Address
First Line : 2331 OAK CREEK DR
Second Line :
City : HERNANDO
State : MS
Zip : 38632-6667
Country : US
Telephone Number : 662-449-4368
Fax Number :
Provider Business Practice Location Address
First Line : 315 W MAIN ST
Second Line :
City : CHARLESTON
State : MS
Zip : 38921-2232
Country : US
Telephone Number : 662-647-5541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 07/08/2007

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