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NPI Code Detail

MEDICARE: LISA BLACK MASON PHARM.D.

MEDICARE: LISA BLACK MASON PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist14027AL
2183500000XPharmacistPS35472FL

General Provider Information

NPI Number : 1396028270
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA BLACK MASON PHARM.D.
Provider Business Mailing Address
First Line : 1226 FREEPORT HWY S
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32435-3396
Country : US
Telephone Number : 850-892-6914
Fax Number : 850-892-0827
Provider Business Practice Location Address
First Line : 1103 US HIGHWAY 331 S
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32435-3383
Country : US
Telephone Number : 850-951-9880
Fax Number : 850-951-9886
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2011
Last Update Date : 05/26/2022

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Directions to “ LISA BLACK MASON PHARM.D.” Practice Location

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