MEDICARE: JM BAILEY PHARM

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
1	3336C0003X	Community/Retail Pharmacy	PHRE005248	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1155351	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1588700199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JM BAILEY PHARM

Provider Business Mailing Address
First Line	:	301 SHIRLEY AVE
Second Line	:
City	:	DOUGLAS
State	:	GA
Zip	:	31533-2333
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 SHIRLEY AVE
Second Line	:
City	:	DOUGLAS
State	:	GA
Zip	:	31533-2333
Country	:	US
Telephone Number	:	912-384-7026
Fax Number	:	912-384-9954

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JERRELL BAILEY
Credential	:
Telephone Number	:	912-384-7028

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/22/2020

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Directions to “JM BAILEY PHARM ” Practice Location

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