Provider Demographics
NPI:1568610343
Name:BAILEY, JESSICA SUZANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:SUZANNE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20648 E COUNTY ROAD 1140
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-2085
Mailing Address - Country:US
Mailing Address - Phone:479-461-4050
Mailing Address - Fax:918-962-5750
Practice Address - Street 1:20648 E COUNTY ROAD 1140
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2085
Practice Address - Country:US
Practice Address - Phone:479-461-4050
Practice Address - Fax:918-962-5750
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13974183500000X
AR10333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist