Provider Demographics
NPI:1144592676
Name:BACON, MERIAH (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:MERIAH
Middle Name:
Last Name:BACON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5680 BALBOA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2706
Mailing Address - Country:US
Mailing Address - Phone:858-309-6565
Mailing Address - Fax:858-309-6575
Practice Address - Street 1:5680 BALBOA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2706
Practice Address - Country:US
Practice Address - Phone:858-309-6565
Practice Address - Fax:858-309-6575
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist