Provider Demographics
NPI:1689955544
Name:MATTHEWS, BAILEY ANN (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:ANN
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PINECREST AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-4326
Mailing Address - Country:US
Mailing Address - Phone:715-345-7175
Mailing Address - Fax:715-345-1745
Practice Address - Street 1:1500 PINECREST AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-4326
Practice Address - Country:US
Practice Address - Phone:715-345-7175
Practice Address - Fax:715-345-1745
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14663-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist