Provider Demographics
NPI:1508193947
Name:BAILEY, MARK L (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:M
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 WHITETAIL TRL
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-7549
Mailing Address - Country:US
Mailing Address - Phone:919-333-3609
Mailing Address - Fax:
Practice Address - Street 1:252 WHITETAIL TRL
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-7549
Practice Address - Country:US
Practice Address - Phone:919-333-3609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03135370183500000X
SC35934183500000X
NC018767183500000X
FLPS 43348183500000X
VA0202207416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist