Provider Demographics
NPI:1588289789
Name:SHERRY, BAILEY LANE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BAILEY
Middle Name:LANE
Last Name:SHERRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:LANE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1100 S SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-2512
Mailing Address - Country:US
Mailing Address - Phone:417-326-2416
Mailing Address - Fax:
Practice Address - Street 1:1100 S SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2512
Practice Address - Country:US
Practice Address - Phone:417-326-2416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190259991835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care