Provider Demographics
NPI:1972994788
Name:BAILEY, JERAD LEE (PHARMD)
Entity type:Individual
Prefix:MR
First Name:JERAD
Middle Name:LEE
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 1:5722 CABIN CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:DAWES
Mailing Address - State:WV
Mailing Address - Zip Code:25054
Mailing Address - Country:US
Mailing Address - Phone:304-595-5065
Mailing Address - Fax:
Practice Address - Street 1:5722 CABIN CREEK ROAD
Practice Address - Street 2:
Practice Address - City:DAWES
Practice Address - State:WV
Practice Address - Zip Code:25054
Practice Address - Country:US
Practice Address - Phone:304-595-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV7694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist