Provider Demographics
NPI:1033713581
Name:MASON, KRISTEN LEE
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LEE
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5361 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6402
Mailing Address - Country:US
Mailing Address - Phone:941-378-4700
Mailing Address - Fax:941-387-2412
Practice Address - Street 1:5361 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6402
Practice Address - Country:US
Practice Address - Phone:941-378-4700
Practice Address - Fax:941-387-2412
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist