Dwaynie Bacon Jr.

Primary specialty

PharmacistTaxonomy code 183500000X

License

S026811 Issued in AZ

Practice address

2410 Highway 95
Bullhead City, AZ 86442-7305

Phone

(928) 219-4700

NPI assigned

Apr 24, 2025

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mojave Medication Management PLLC

  • Managed Care Organization Pharmacy
  • Bullhead City, AZ
  • NPI 1922990290
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1745452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745452800000",
    "number": "1366239980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2328 RYAN WAY",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864428699",
            "telephone_number": "702-292-3798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 HIGHWAY 95",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864427305",
            "telephone_number": "928-219-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "DWAYNIE",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-04-24",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AZ",
            "license": "S026811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Summer Charise Aymar, DO
• Az Community Care
• Bashir A Azher, MD
• Freeha Afshin Azher, MD
• Abdul Aziz, MD
• Paige Theresa Bafus, DDS
• Richard Lefroy Bailey, M.D.
• Banner -- University Medical Center Phoenix Campus Liver Disease Servi
• Amy G Barnard, NP
• Philip Charles Barnard, D.C.

• Pharmacist in Bullhead City, AZ
• Providers in Bullhead City, AZ by specialty
• Pharmacist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.