MEDICARE: MS. LOIS ELAINE MASTIN R.PH.

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	6198658-1701	UT

General Provider Information

NPI Number	:	1700743507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LOIS ELAINE MASTIN R.PH.

Provider Business Mailing Address
First Line	:	12553 ROSS CREEK DR
Second Line	:
City	:	KAMAS
State	:	UT
Zip	:	84036-9324
Country	:	US
Telephone Number	:	801-209-9438
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 UINTA WAY
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-1468
Country	:	US
Telephone Number	:	435-649-7606
Fax Number	:

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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