Provider Demographics
NPI:1083404552
Name:BACA, JAMISON MYA (PHARMD)
Entity type:Individual
Prefix:
First Name:JAMISON
Middle Name:MYA
Last Name:BACA
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11065 CANYONBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-6988
Mailing Address - Country:US
Mailing Address - Phone:303-913-1018
Mailing Address - Fax:
Practice Address - Street 1:7901 E LOWRY BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6507
Practice Address - Country:US
Practice Address - Phone:303-913-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist