Provider Demographics
NPI:1073115069
Name:WALTZ, MASON EUGENE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MASON
Middle Name:EUGENE
Last Name:WALTZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 MISTY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-6494
Mailing Address - Country:US
Mailing Address - Phone:419-889-5522
Mailing Address - Fax:
Practice Address - Street 1:1611 TRENTON AVENUE
Practice Address - Street 2:WAL-MART PHARMACY
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840
Practice Address - Country:US
Practice Address - Phone:419-425-5992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist