Provider Demographics
NPI:1205206307
Name:BAILEY, TERRI BRITTANY (PHARM D)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:BRITTANY
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 BLANKENSHIP DR
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4525
Mailing Address - Country:US
Mailing Address - Phone:859-582-8682
Mailing Address - Fax:
Practice Address - Street 1:2204 S 5TH ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-5318
Practice Address - Country:US
Practice Address - Phone:337-238-9305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020983183500000X
KY015205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist