Provider Demographics
NPI:1245588052
Name:BAILEY, MICHAEL ALAN (RPH, DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:RPH, DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 MAYBANK HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2103
Mailing Address - Country:US
Mailing Address - Phone:843-795-0792
Mailing Address - Fax:843-762-3210
Practice Address - Street 1:1739 MAYBANK HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2103
Practice Address - Country:US
Practice Address - Phone:843-795-0792
Practice Address - Fax:843-762-3210
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC010953183500000X
GA014625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist