Provider Demographics
NPI:1306888128
Name:BAILEY PHARMACY INC
Entity type:Organization
Organization Name:BAILEY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:252-235-3562
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:NC
Mailing Address - Zip Code:27807-0158
Mailing Address - Country:US
Mailing Address - Phone:252-235-3562
Mailing Address - Fax:252-235-2373
Practice Address - Street 1:6311 DEANS ST
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:NC
Practice Address - Zip Code:27807-8641
Practice Address - Country:US
Practice Address - Phone:252-235-3562
Practice Address - Fax:252-235-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
NC130493336C0003X
NC9124335E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2065007OtherPK
NC064518Medicaid
NC064518Medicaid
NC0463470001Medicare NSC