Provider Demographics
NPI:1174892384
Name:BAILEY, KEITH ALAN (RPH)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ALAN
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 1:440 COLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:VINE GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:40175-6139
Mailing Address - Country:US
Mailing Address - Phone:270-828-4446
Mailing Address - Fax:
Practice Address - Street 1:635 S DIXIE BLVD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-1219
Practice Address - Country:US
Practice Address - Phone:270-352-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist