Provider Demographics
NPI:1699396812
Name:MASOOD, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MASOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9026 NOPAH PEAK CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-9331
Mailing Address - Country:US
Mailing Address - Phone:630-512-1075
Mailing Address - Fax:
Practice Address - Street 1:600 PILOT RD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-9011
Practice Address - Country:US
Practice Address - Phone:800-874-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
19755OtherNVBOP LICENSE