=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750880480
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | R DOUGLAS MASON D.PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2018
-----------------------------------------------------
Last Update Date | 02/08/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10900 PARKSIDE DR
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37934-1958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-777-5180
-----------------------------------------------------
Fax | 865-777-5186
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 930 OAK CHASE BLVD
-----------------------------------------------------
City | LENOIR CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37772-6961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-659-9330
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 6120
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------