Individual
BRYAN BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
550 POPE AVE, FORT LEAVENWORTH, KS 66027-2332
(913) 684-6070
Mailing address
300 REAGAN DR, LANSING, KS 66043-1737
(913) 250-6701
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
1-16367
KS
Other
Enumeration date
10/24/2010
Last updated
09/18/2014
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