MEDICARE: DR. MOLLY ANN MASON 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	26023563A	IN
2	183500000X	Pharmacist	051294190	IL

General Provider Information

NPI Number	:	1881987477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOLLY ANN MASON PHARMD

Provider Business Mailing Address
First Line	:	2890 SPRING MEADOW CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-4228
Country	:	US
Telephone Number	:	765-585-4682
Fax Number	:

Provider Business Practice Location Address
First Line	:	2890 SPRING MEADOW CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-4228
Country	:	US
Telephone Number	:	765-585-4682
Fax Number	:

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

Provider Enumeration Date	:	05/16/2011
Last Update Date	:	05/16/2011

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