Provider Demographics
NPI:1326649179
Name:HOLMAN, MASON DANE
Entity Type:Individual
Prefix:DR
First Name:MASON
Middle Name:DANE
Last Name:HOLMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2137
Mailing Address - Country:US
Mailing Address - Phone:405-577-0051
Mailing Address - Fax:405-577-0053
Practice Address - Street 1:1001 E MAIN ST
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2137
Practice Address - Country:US
Practice Address - Phone:405-577-0051
Practice Address - Fax:405-577-0053
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist