Provider Demographics
NPI:1497900732
Name:MASON PHARMACIST GROUP LLC
Entity Type:Organization
Organization Name:MASON PHARMACIST GROUP LLC
Other - Org Name:MASON FAMILY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-498-0136
Mailing Address - Street 1:912 KENTON STATION DR
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-9658
Mailing Address - Country:US
Mailing Address - Phone:606-759-0700
Mailing Address - Fax:606-759-0708
Practice Address - Street 1:912 KENTON STATION DR
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9658
Practice Address - Country:US
Practice Address - Phone:606-759-0700
Practice Address - Fax:606-759-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP07317332BX2000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1830961OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1830961OtherNCPDP PROVIDER IDENTIFICATION NUMBER