Individual
OPAL M BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1 FORD PLACE, 1C, OUTPATIENT PSYCHIATRY, DETROIT, MI 48202
(313) 556-7882
(313) 874-6650
Mailing address
2065 ANITA AVE, GROSSE POINTE WOODS, MI 48236-1427
Taxonomy
Speciality
Code
Description
License number
State
1835P1300X
Psychiatric Pharmacist
Primary
5302044753
MI
Other
Enumeration date
11/21/2016
Last updated
11/21/2016
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