Provider Demographics
NPI:1417547712
Name:MELBUER, MASON MUSKE
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:MUSKE
Last Name:MELBUER
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 1:7410 S HAYFORD RD APT A301
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-9818
Mailing Address - Country:US
Mailing Address - Phone:360-609-2481
Mailing Address - Fax:
Practice Address - Street 1:2105 E WELLESLEY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-4271
Practice Address - Country:US
Practice Address - Phone:509-483-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61076113333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy