Healthcare Provider Details

I. General information

NPI: 1295202083
Provider Name (Legal Business Name): MASON MATTHEW MCDOWELL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 GARNET AVE
SAN DIEGO CA
92109-3116
US

IV. Provider business mailing address

5681 DESERT VIEW DR
LA JOLLA CA
92037-7239
US

V. Phone/Fax

Practice location:
  • Phone: 858-270-1163
  • Fax: 858-270-1178
Mailing address:
  • Phone: 509-929-0989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79887
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: