MEDICARE: WARREN MASTERS

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	0202207708	VA

General Provider Information

NPI Number	:	1831497049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WARREN MASTERS

Provider Business Mailing Address
First Line	:	1415 CEDAR RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-7107
Country	:	US
Telephone Number	:	757-436-0443
Fax Number	:	757-547-4845

Provider Business Practice Location Address
First Line	:	1415 CEDAR RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-7107
Country	:	US
Telephone Number	:	757-436-0443
Fax Number	:	757-547-4845

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

Provider Enumeration Date	:	03/11/2011
Last Update Date	:	03/11/2011

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