Provider Demographics
NPI:1407963242
Name:BAILEY, LOIS ANN (MD, RPH)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:ANN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1575
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-1575
Mailing Address - Country:US
Mailing Address - Phone:916-652-5633
Mailing Address - Fax:
Practice Address - Street 1:6119 HORSESHOE BAR RD
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-8528
Practice Address - Country:US
Practice Address - Phone:916-652-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH55263183500000X
FLPS39116183500000X
AZ14393183500000X
CT10189183500000X
HIPH2450183500000X
CAG54816208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G548160Medicaid
CAA52800Medicare UPIN
00G548160Medicare ID - Type Unspecified