Thomas Bacon, PHARMD

Key facts

NPI

1124428529

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist 183500000X

License

RPH016043 (GA)

Practice address

4700 Las Vegas Blvd N
99 Mdos/CC
Nellis Afb, NV 89191-6600

Phone

(702) 653-2031

Fax

(702) 653-2110

NPI assigned

Sep 4, 2014

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Doctor of Pharmacy

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 4, 2014.

{
    "created_epoch": "1409788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409788800000",
    "number": "1124428529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "address_2": "99 MEDICAL OPERATIONS SQUADRON / COMMANDER",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-2031",
            "fax_number": "702-653-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "address_2": "99 MDOS/CC",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-2031",
            "fax_number": "702-653-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-04",
        "last_updated": "2014-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH016043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nellis Afb, NV

• Ignacio J O Aricheta, APRN
• Matthew Aaron Armstrong, M.D.
• Travis Atkinson Arnold-Lloyd, MD
• Daron Atkin, DO
• Alexis C Aust, MD
• Justin Baggette, CRNA, DNP, RN
• Brigham Bahr, DO
• Kevin Donald Bailey, PA-C
• Carlene J Bainter, PA-C
• Preston H Baker

All providers in Nellis Afb, NV · Pharmacist in Nevada