Provider Demographics
NPI:1144453069
Name:BAILEY, JON MARK (RPH)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:MARK
Last Name:BAILEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 CENTRAL AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2263
Mailing Address - Country:US
Mailing Address - Phone:505-262-1745
Mailing Address - Fax:505-262-9324
Practice Address - Street 1:2950 CENTRAL AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2263
Practice Address - Country:US
Practice Address - Phone:505-262-1745
Practice Address - Fax:505-262-9324
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist