Active NPI
Derrick Bacon, PHARMACY TECH
- Pharmacy Technician
- Pontiac, MI
National Provider Identifier
1104544071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- 5303041916
- Practice address
- 360 Martin Luther King Jr Blvd N
Pontiac, MI 48342-1712 - Phone
- (248) 332-0602
- NPI assigned
- Aug 17, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | 5303041916 | MI | Primary |
Addresses
Primary practice location
360 Martin Luther King Jr Blvd N
Pontiac, MI 48342-1712
Mailing address
360 Martin Luther King Jr Blvd N
Pontiac, MI 48342-1712
Phone (248) 332-0602
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5303041916 | MI | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660694400000",
"number": "1104544071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "360 MARTIN LUTHER KING JR BLVD N",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483421712",
"telephone_number": "248-332-0602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "360 MARTIN LUTHER KING JR BLVD N",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483421712",
"telephone_number": "248-332-0602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACON",
"first_name": "DERRICK",
"credential": "PHARMACY TECH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-17",
"last_updated": "2022-08-17",
"certification_date": "2022-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "MI",
"license": "5303041916",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.