Provider Demographics
NPI:1982987509
Name:BACON, ANA M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:M
Last Name:BACON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 LAKE BLVD E
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-2913
Mailing Address - Country:US
Mailing Address - Phone:530-229-1519
Mailing Address - Fax:
Practice Address - Street 1:115 LAKE BLVD E
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-2913
Practice Address - Country:US
Practice Address - Phone:530-229-1519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64659183500000X
NE13580183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist