Healthcare Provider Details

I. General information

NPI: 1497900732
Provider Name (Legal Business Name): MASON PHARMACIST GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 KENTON STATION DR
MAYSVILLE KY
41056-9658
US

IV. Provider business mailing address

912 KENTON STATION DR
MAYSVILLE KY
41056-9658
US

V. Phone/Fax

Practice location:
  • Phone: 606-759-0700
  • Fax: 606-759-0708
Mailing address:
  • Phone: 606-759-0700
  • Fax: 606-759-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberP07317
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07317
License Number StateKY

VIII. Authorized Official

Name: SHERRY STEVENS
Title or Position: OFFICE MANAGER
Credential:
Phone: 859-498-0136