Provider Demographics
NPI:1477150241
Name:BAILEY, TYLER ALAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ALAN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 SILVER MAPLE RDG APT 14
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25306-1147
Mailing Address - Country:US
Mailing Address - Phone:304-881-1265
Mailing Address - Fax:
Practice Address - Street 1:700 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-2000
Practice Address - Country:US
Practice Address - Phone:304-872-4980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP00117163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy