Provider Demographics
NPI:1992421317
Name:BAILEY, MARTIN SEBASTIAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:SEBASTIAN
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 1:13381 MAGNOLIA AVE SPC 132
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1945
Mailing Address - Country:US
Mailing Address - Phone:951-768-2136
Mailing Address - Fax:
Practice Address - Street 1:125 E CLUB CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-4107
Practice Address - Country:US
Practice Address - Phone:909-651-4705
Practice Address - Fax:909-558-5958
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist