Provider Demographics
NPI:1922990290
Name:MOJAVE MEDICATION MANAGEMENT PLLC
Entity type:Organization
Organization Name:MOJAVE MEDICATION MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BACON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:282-960-2389
Mailing Address - Street 1:2328 RYAN WAY
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8699
Mailing Address - Country:US
Mailing Address - Phone:702-292-3798
Mailing Address - Fax:
Practice Address - Street 1:2328 RYAN WAY
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8699
Practice Address - Country:US
Practice Address - Phone:928-296-0238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy