Provider Demographics
NPI:1902160625
Name:BAYLESS, ANDREW CHRISTIAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CHRISTIAN
Last Name:BAYLESS
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:PO BOX 130 EAST HWY 262
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA CREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84534
Mailing Address - Country:US
Mailing Address - Phone:435-651-3291
Mailing Address - Fax:435-651-3189
Practice Address - Street 1:EAST HWY 262
Practice Address - Street 2:MONTEZUMA CREEK CLINIC
Practice Address - City:MONTEZUMA CREEK
Practice Address - State:UT
Practice Address - Zip Code:84534
Practice Address - Country:US
Practice Address - Phone:435-651-3291
Practice Address - Fax:435-651-3189
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7009029-17011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist