Provider Demographics
NPI:1114105723
Name:MASTERSON, MICHAEL DAVID (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:MASTERSON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4154
Mailing Address - Country:US
Mailing Address - Phone:518-831-4434
Mailing Address - Fax:518-831-4562
Practice Address - Street 1:3 CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-4154
Practice Address - Country:US
Practice Address - Phone:518-831-4434
Practice Address - Fax:518-831-4562
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0497151835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology