Provider Demographics
NPI:1184358434
Name:LAWRENCE, BAILEY (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:
Last Name:LAWRENCE
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 1:1823 NEW RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2603
Mailing Address - Country:US
Mailing Address - Phone:662-315-9203
Mailing Address - Fax:
Practice Address - Street 1:6670 STAGE RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3810
Practice Address - Country:US
Practice Address - Phone:901-384-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45434183500000X
MSE-100248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN45434OtherPHARMACIST LICENSE