Healthcare Provider Details

I. General information

NPI: 1043811987
Provider Name (Legal Business Name): PHILLIP ROSS MASTERS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N 7TH ST
CHARITON IA
50049-1210
US

IV. Provider business mailing address

1200 N 7TH ST
CHARITON IA
50049-1210
US

V. Phone/Fax

Practice location:
  • Phone: 641-774-3127
  • Fax: 641-774-8087
Mailing address:
  • Phone: 641-774-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number23859
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: