Provider Demographics
NPI:1275257719
Name:BAILEY, CLARISSA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:
Other - Last Name:MEDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:129 CLAWSON RD
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-5117
Mailing Address - Country:US
Mailing Address - Phone:423-494-8755
Mailing Address - Fax:
Practice Address - Street 1:US HWY 441 HWY 25E
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965
Practice Address - Country:US
Practice Address - Phone:606-248-6288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46465183500000X
KY023102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist