Provider Demographics
NPI:1285712315
Name:MAZON, ELADIO (RPH)
Entity type:Individual
Prefix:
First Name:ELADIO
Middle Name:
Last Name:MAZON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-9531
Mailing Address - Country:US
Mailing Address - Phone:304-364-5027
Mailing Address - Fax:304-847-2800
Practice Address - Street 1:324 MILLER MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:WEBSTER SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:26288-1026
Practice Address - Country:US
Practice Address - Phone:304-847-5151
Practice Address - Fax:304-847-2800
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist