Healthcare Provider Details

I. General information

NPI: 1124759576
Provider Name (Legal Business Name): TIMOTHY MICHAEL MASON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 TUSCAN WAY
SAINT AUGUSTINE FL
32092-1831
US

IV. Provider business mailing address

84 TUSCAN WAY
SAINT AUGUSTINE FL
32092-1831
US

V. Phone/Fax

Practice location:
  • Phone: 904-940-2894
  • Fax: 904-940-2899
Mailing address:
  • Phone: 904-940-2894
  • Fax: 904-940-2899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS64122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: