MEDICARE: CHARLES E MASON 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	019623	LA

General Provider Information

NPI Number	:	1376827535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES E MASON III PHARMD

Provider Business Mailing Address
First Line	:	3225 LOUISIANA AVE
Second Line	:	T-2377
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-1406
Country	:	US
Telephone Number	:	337-769-7516
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 LOUISIANA AVE
Second Line	:	T-2377
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-1406
Country	:	US
Telephone Number	:	337-769-7516
Fax Number	:

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

Provider Enumeration Date	:	10/06/2011
Last Update Date	:	10/06/2011

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