Provider Demographics
NPI:1427771450
Name:BAILEY, REBECCA KATHLEEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:KATHLEEN
Last Name:BAILEY
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 1:811 MAHALA DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-3265
Mailing Address - Country:US
Mailing Address - Phone:618-340-3681
Mailing Address - Fax:
Practice Address - Street 1:100 ADMIRAL TROST RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-1996
Practice Address - Country:US
Practice Address - Phone:618-281-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.304888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist