Active NPI
Jonathan Mark Bacon, R.PH.
- Pharmacist
- Charlotte, NC
National Provider Identifier
1386924348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 7757
- Practice address
- 1533 South Blvd
Charlotte, NC 28203-4723 - Phone
- (704) 342-4558
- NPI assigned
- Aug 23, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 7757 | NC | Primary |
Addresses
Primary practice location
1533 South Blvd
Charlotte, NC 28203-4723
Mailing address
701 Royal CT
Apt # 705
Charlotte, NC 28202-2748
Phone (704) 516-5219
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7757 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314057600000",
"number": "1386924348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 ROYAL CT",
"address_2": "APT # 705",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282022748",
"telephone_number": "704-516-5219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1533 SOUTH BLVD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282034723",
"telephone_number": "704-342-4558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACON",
"first_name": "JONATHAN",
"middle_name": "MARK",
"name_prefix": "Mr.",
"credential": "R.PH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-23",
"last_updated": "2011-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "7757",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.