Provider Demographics
NPI:1619572864
Name:BAILEY, KRISTIN DIANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:DIANN
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 1:3403 82ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423
Mailing Address - Country:US
Mailing Address - Phone:806-241-0010
Mailing Address - Fax:806-797-2163
Practice Address - Street 1:3403 82ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423
Practice Address - Country:US
Practice Address - Phone:806-797-3888
Practice Address - Fax:806-797-2163
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist