Provider Demographics
NPI:1265793632
Name:MATHIS, MASON REESE III (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MASON
Middle Name:REESE
Last Name:MATHIS
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1584 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-5528
Mailing Address - Country:US
Mailing Address - Phone:843-871-9289
Mailing Address - Fax:843-871-2925
Practice Address - Street 1:1584 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-5528
Practice Address - Country:US
Practice Address - Phone:843-871-9289
Practice Address - Fax:843-871-2925
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC13687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist