Provider Demographics
NPI:1154936219
Name:FOWLER, BAILEY BRIANNE (PHARMD)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:BRIANNE
Last Name:FOWLER
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 1:301 RIDGECREST LN
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-4481
Mailing Address - Country:US
Mailing Address - Phone:256-762-5231
Mailing Address - Fax:
Practice Address - Street 1:1410 FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2700
Practice Address - Country:US
Practice Address - Phone:256-712-6198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist