Provider Demographics
NPI:1184233579
Name:BAILEY, KATHLENE ELIZABETH (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHLENE
Middle Name:ELIZABETH
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 W CARDINAL AVE
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8865
Mailing Address - Country:US
Mailing Address - Phone:208-590-2936
Mailing Address - Fax:
Practice Address - Street 1:3050 E MULLAN AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-8939
Practice Address - Country:US
Practice Address - Phone:208-777-4502
Practice Address - Fax:208-777-8033
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP89231835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist