Provider Demographics
NPI:1417551920
Name:BAILES, ZACHARY (RPH)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:BAILES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 MORNING GLORY DR
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-8409
Mailing Address - Country:US
Mailing Address - Phone:859-612-9145
Mailing Address - Fax:
Practice Address - Street 1:7500 BEECHMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-4206
Practice Address - Country:US
Practice Address - Phone:513-231-4591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03237231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist