Healthcare Provider Details

I. General information

NPI: 1902806441
Provider Name (Legal Business Name): BARBARA J MASON PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA MEDICAL CENTER 119A 500 W FORT
BOISE ID
83702
US

IV. Provider business mailing address

1803 DANMORE DR
BOISE ID
83712-6608
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1146
  • Fax: 208-422-1147
Mailing address:
  • Phone: 208-344-5324
  • Fax: 208-422-1147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP4678
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: