Provider Demographics
NPI:1003958018
Name:ROBERT H BAILEY
Entity Type:Organization
Organization Name:ROBERT H BAILEY
Other - Org Name:FRONTIER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-366-1417
Mailing Address - Street 1:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:BIG PINEY
Mailing Address - State:WY
Mailing Address - Zip Code:83113-0990
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 NICHOLS ST
Practice Address - Street 2:
Practice Address - City:BIG PINEY
Practice Address - State:WY
Practice Address - Zip Code:83113
Practice Address - Country:US
Practice Address - Phone:307-276-3499
Practice Address - Fax:307-276-3518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYR100363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY12584000Medicaid
5202584OtherNCPDP PROVIDER IDENTIFICATION NUMBER