Provider Demographics
NPI:1790449833
Name:HALLEWELL, MASON LEONARD (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:LEONARD
Last Name:HALLEWELL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 ECHO BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1183
Mailing Address - Country:US
Mailing Address - Phone:317-701-5468
Mailing Address - Fax:
Practice Address - Street 1:555 ECHO BEND BLVD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1183
Practice Address - Country:US
Practice Address - Phone:317-701-5468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017943A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist