Provider Demographics
NPI:1629796545
Name:BAILEY, COLLETTE AZURE (RPH)
Entity Type:Individual
Prefix:
First Name:COLLETTE
Middle Name:AZURE
Last Name:BAILEY
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 1:8151 E PALMER WASILLA HWY
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8468
Mailing Address - Country:US
Mailing Address - Phone:907-561-3211
Mailing Address - Fax:907-561-4652
Practice Address - Street 1:8151 E PALMER WASILLA HWY
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8468
Practice Address - Country:US
Practice Address - Phone:907-561-3211
Practice Address - Fax:907-561-4652
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK178783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK178783OtherPHARMACIST LICENSE NUMBER THROUGH STATE OF ALASKA BOARD OF PHARMACY