Provider Demographics
NPI:1598892788
Name:BAILEY, GARY BRANDON JR (PHARM D)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:BRANDON
Last Name:BAILEY
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 LINCOLN PL
Mailing Address - Street 2:E-2
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-3626
Mailing Address - Country:US
Mailing Address - Phone:912-506-6480
Mailing Address - Fax:
Practice Address - Street 1:5711 ALTAMA AVE
Practice Address - Street 2:SUITE J
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-2240
Practice Address - Country:US
Practice Address - Phone:912-264-2622
Practice Address - Fax:912-264-1392
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist