Provider Demographics
NPI:1952881559
Name:BAILEY, TAYLOR
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BAILEY
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 1:44164 US HIGHWAY 78
Mailing Address - Street 2:UNIT 202
Mailing Address - City:LINCOLN
Mailing Address - State:AL
Mailing Address - Zip Code:35096
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 COMMONS WAY
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-3483
Practice Address - Country:US
Practice Address - Phone:256-835-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2020-03-10
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2020-03-10
Provider Licenses
StateLicense IDTaxonomies
AL20554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
20554OtherLICENSE NUMBER