Provider Demographics
NPI:1558897678
Name:BAILEY, WILLIAM FRANKLIN (PHARMD RPH)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FRANKLIN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:PHARMD RPH
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:FRANKLIN
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD RPH
Mailing Address - Street 1:415 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2322
Mailing Address - Country:US
Mailing Address - Phone:574-208-6684
Mailing Address - Fax:574-367-2026
Practice Address - Street 1:415 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2322
Practice Address - Country:US
Practice Address - Phone:574-208-6684
Practice Address - Fax:574-367-2026
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021519A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26021519AOtherSTATE LICENSE