MEDICARE: DR. MASON REESE MATHIS III PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	13687	SC

General Provider Information

NPI Number	:	1265793632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MASON REESE MATHIS III PHARMD

Provider Business Mailing Address
First Line	:	1584 CENTRAL AVE
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-5528
Country	:	US
Telephone Number	:	843-871-9289
Fax Number	:	843-871-2925

Provider Business Practice Location Address
First Line	:	1584 CENTRAL AVE
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-5528
Country	:	US
Telephone Number	:	843-871-9289
Fax Number	:	843-871-2925

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2012
Last Update Date	:	08/07/2020

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