Provider Demographics
NPI:1831931179
Name:NEALON, BAILEE NICHOLE-MILLER
Entity type:Individual
Prefix:MRS
First Name:BAILEE
Middle Name:NICHOLE-MILLER
Last Name:NEALON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 DUTCHMANS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:MD
Mailing Address - Zip Code:21716-9770
Mailing Address - Country:US
Mailing Address - Phone:301-834-4805
Mailing Address - Fax:
Practice Address - Street 1:1201 DUTCHMANS CREEK DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:MD
Practice Address - Zip Code:21716-9770
Practice Address - Country:US
Practice Address - Phone:301-834-4805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT23737183500000X
MD30264716183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist