Healthcare Provider Details

I. General information

NPI: 1295746873
Provider Name (Legal Business Name): BACON EAST PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 HIGH SCHOOL AVE STE 114
CONCORD CA
94520-1816
US

IV. Provider business mailing address

2485 HIGH SCHOOL AVE STE 114
CONCORD CA
94520-1816
US

V. Phone/Fax

Practice location:
  • Phone: 925-687-0565
  • Fax: 925-687-7925
Mailing address:
  • Phone: 925-687-0565
  • Fax: 925-687-7925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY53596
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SEAN WEEKES
Title or Position: PIC
Credential: BS. PHARM
Phone: 925-687-0565