Provider Demographics
NPI:1386089282
Name:BAILEY, JOHN LOGAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LOGAN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 CREST LNDG
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2256
Mailing Address - Country:US
Mailing Address - Phone:256-490-4739
Mailing Address - Fax:
Practice Address - Street 1:809 UNIVERSITY BOULEVARD
Practice Address - Street 2:DCH REGIONAL MEDICAL CENTER
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401
Practice Address - Country:US
Practice Address - Phone:205-726-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS10582390200000X
AL19292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program