Provider Demographics
NPI:1831497049
Name:MASTERS, WARREN
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:MASTERS
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 1:1415 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7107
Mailing Address - Country:US
Mailing Address - Phone:757-436-0443
Mailing Address - Fax:757-547-4845
Practice Address - Street 1:1415 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-7107
Practice Address - Country:US
Practice Address - Phone:757-436-0443
Practice Address - Fax:757-547-4845
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist