Provider Demographics
NPI:1861176877
Name:BAXLEY WELLNESS PHARMACY INC. LONG-TERM CARE
Entity type:Organization
Organization Name:BAXLEY WELLNESS PHARMACY INC. LONG-TERM CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:BAXLEY
Authorized Official - Last Name:AYCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-245-4270
Mailing Address - Street 1:160 AZALEA RD
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-9195
Mailing Address - Country:US
Mailing Address - Phone:912-705-3784
Mailing Address - Fax:912-705-7819
Practice Address - Street 1:160 AZALEA RD
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-9195
Practice Address - Country:US
Practice Address - Phone:912-705-3784
Practice Address - Fax:912-705-7819
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAXLEY WELLNESS PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy