Provider Demographics
NPI:1629472006
Name:BAGLEY, DAWN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8174 OCEAN GTWY
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7144
Mailing Address - Country:US
Mailing Address - Phone:410-763-6907
Mailing Address - Fax:
Practice Address - Street 1:8174 OCEAN GTWY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7144
Practice Address - Country:US
Practice Address - Phone:410-763-6907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist