Provider Demographics
NPI:1083284202
Name:ANTER, MASON ALLEN (CPHT)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:ALLEN
Last Name:ANTER
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-8658
Mailing Address - Country:US
Mailing Address - Phone:810-735-1341
Mailing Address - Fax:810-735-4191
Practice Address - Street 1:602 W BROAD ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:MI
Practice Address - Zip Code:48451-8658
Practice Address - Country:US
Practice Address - Phone:810-735-1341
Practice Address - Fax:810-735-4191
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303037372183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5303037372OtherPHARMACY TECHNICIAN LICENSE NUMBER