Provider Demographics
NPI:1891915773
Name:BAILIE, GEORGE R (PHARMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:R
Last Name:BAILIE
Suffix:
Gender:M
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 NEW SCOTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3425
Mailing Address - Country:US
Mailing Address - Phone:518-694-7235
Mailing Address - Fax:518-694-7058
Practice Address - Street 1:106 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3425
Practice Address - Country:US
Practice Address - Phone:518-694-7235
Practice Address - Fax:518-694-7058
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist