Individual
MR. JONATHAN MARK BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
1533 SOUTH BLVD, CHARLOTTE, NC 28203-4723
(704) 342-4558
Mailing address
701 ROYAL CT, APT # 705, CHARLOTTE, NC 28202-2748
(704) 516-5219
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
7757
NC
Other
Enumeration date
08/23/2011
Last updated
08/23/2011
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