Provider Demographics
NPI:1295202083
Name:MCDOWELL, MASON MATTHEW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MASON
Middle Name:MATTHEW
Last Name:MCDOWELL
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 1:5681 DESERT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7239
Mailing Address - Country:US
Mailing Address - Phone:509-929-0989
Mailing Address - Fax:
Practice Address - Street 1:1670 GARNET AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3116
Practice Address - Country:US
Practice Address - Phone:858-270-1163
Practice Address - Fax:858-270-1178
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist