Provider Demographics
NPI:1114040193
Name:MASON, STANLEY E (RPH)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:E
Last Name:MASON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7109 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6238
Mailing Address - Country:US
Mailing Address - Phone:509-465-0396
Mailing Address - Fax:509-483-0343
Practice Address - Street 1:7109 N MONROE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6238
Practice Address - Country:US
Practice Address - Phone:509-465-0396
Practice Address - Fax:509-483-0343
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00010876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00010876OtherWA PHARMACIST LICENSE