Healthcare Provider Details

I. General information

NPI: 1427850031
Provider Name (Legal Business Name): ROBERT MASON CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 05/18/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 GOLF DR
PONTIAC MI
48341-2354
US

IV. Provider business mailing address

35 E HURON ST
PONTIAC MI
48342-2203
US

V. Phone/Fax

Practice location:
  • Phone: 855-445-4554
  • Fax:
Mailing address:
  • Phone: 248-472-1934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5303048885
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: