Provider Demographics
NPI:1417180712
Name:MASON, JOHN C (PHARM/D)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:MASON
Suffix:
Gender:M
Credentials:PHARM/D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39739-0313
Mailing Address - Country:US
Mailing Address - Phone:662-738-4694
Mailing Address - Fax:662-738-5043
Practice Address - Street 1:139 NORTH OLIVER ST.
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:MS
Practice Address - Zip Code:39739
Practice Address - Country:US
Practice Address - Phone:662-738-5041
Practice Address - Fax:662-738-5043
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE010065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist