Provider Demographics
NPI:1669025532
Name:BAILEY, PHILLIP BRUCE
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:BRUCE
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 N WILLIS ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-4621
Mailing Address - Country:US
Mailing Address - Phone:325-677-1362
Mailing Address - Fax:325-677-2428
Practice Address - Street 1:920 N WILLIS ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-4621
Practice Address - Country:US
Practice Address - Phone:325-677-1362
Practice Address - Fax:325-677-2428
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist