Provider Demographics
NPI:1609189570
Name:MASINGILL, MARK TERRY (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:TERRY
Last Name:MASINGILL
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 COPPER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-5815
Mailing Address - Country:US
Mailing Address - Phone:423-307-0019
Mailing Address - Fax:
Practice Address - Street 1:3251 COPPER RIDGE RD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-5815
Practice Address - Country:US
Practice Address - Phone:423-307-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28742183500000X
FL14284183500000X
AL12574183500000X
VA0202208730183500000X
KY7168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist