Individual
DERRICK BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACY TECH
Contact information
Practice address
360 MARTIN LUTHER KING JR BLVD N, PONTIAC, MI 48342-1712
(248) 332-0602
Mailing address
360 MARTIN LUTHER KING JR BLVD N, PONTIAC, MI 48342-1712
(248) 332-0602
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
5303041916
MI
Other
Enumeration date
08/17/2022
Last updated
08/17/2022
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