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General NPI Number Information
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NPI Number | 1114094885
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Entity Type | Individual
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Provider Name | PHILLIP WILSON MASON R.P.H
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Gender | Male
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3656 AL HIGHWAY 69
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City | GUNTERSVILLE
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State | AL
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Zip | 35976-7196
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Country | US
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Telephone | 256-571-7115
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Fax |
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Provider Business Mailing Address
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Address Line | 294 RAINWATER RD
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City | GUNTERSVILLE
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State | AL
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Zip | 35976-7277
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Country | US
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Telephone | 256-582-6439
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 11020
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License Number State | AL
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