Healthcare Provider Details

I. General information

NPI: 1902995921
Provider Name (Legal Business Name): RODNEY RAY MAST RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4925 WEST MAIN STREET
BERLIN OH
44610
US

IV. Provider business mailing address

4805 TR 366 UNIT 263
MILLERSBURG OH
44654
US

V. Phone/Fax

Practice location:
  • Phone: 330-893-3179
  • Fax: 330-893-3019
Mailing address:
  • Phone: 330-893-2547
  • Fax: 330-893-9933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: