Provider Demographics
NPI:1649251307
Name:BAILLY, JASON (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:BAILLY
Suffix:
Gender:M
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 1:4168 FRONT ST # 1-127
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2030
Mailing Address - Country:US
Mailing Address - Phone:619-543-5933
Mailing Address - Fax:619-543-6784
Practice Address - Street 1:4168 FRONT ST # 1-127
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2030
Practice Address - Country:US
Practice Address - Phone:619-543-5933
Practice Address - Fax:619-543-6784
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH607711835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist