Individual
JOSHUA BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
HIGHWAY 666 NORTH, MEDICAL CENTER COMPLEX, SHIPROCK, NM 87420
(505) 368-7227
Mailing address
PO BOX 829, FLORA VISTA, NM 87415-0829
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S016886
AZ
Other
Enumeration date
09/09/2010
Last updated
09/09/2010
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