Provider Demographics
NPI:1124603022
Name:MASON, DEBORAH L (RPH)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:MASON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5056 ROCKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-2435
Mailing Address - Country:US
Mailing Address - Phone:716-909-1546
Mailing Address - Fax:
Practice Address - Street 1:5056 ROCKHAVEN DR
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-2435
Practice Address - Country:US
Practice Address - Phone:716-909-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist