MEDICARE: J M BAILEY PHARMACY INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHRE005248	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2014028	OTHER		PK

General Provider Information

NPI Number	:	1700925500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J M BAILEY PHARMACY INC

Provider Business Mailing Address
First Line	:	301 SHIRLEY AVE
Second Line	:
City	:	DOUGLAS
State	:	GA
Zip	:	31533-2333
Country	:	US
Telephone Number	:	912-384-7026
Fax Number	:	912-384-9554

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	:	912-384-9554

Authorized Official
Title or Position	:	PRES OF CORP
Name	:	JERRELL BAILEY
Credential	:
Telephone Number	:	912-384-7026

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	02/21/2017

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