Provider Demographics
NPI:1831710367
Name:BREWER, BAILEY NICOLE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:NICOLE
Last Name:BREWER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:BAILEY
Other - Middle Name:NICOLE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2425 DAVE WARD DR STE 602
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8685
Mailing Address - Country:US
Mailing Address - Phone:501-336-8188
Mailing Address - Fax:501-336-8177
Practice Address - Street 1:2425 DAVE WARD DR STE 602
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8685
Practice Address - Country:US
Practice Address - Phone:501-336-8188
Practice Address - Fax:501-336-8177
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist