Provider Demographics
NPI:1629026943
Name:GUSAKOV-MASON, MARY ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:GUSAKOV-MASON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6900 NORTH PECOS ROAD
Mailing Address - Street 2:PHARMACY DEPARTMENT #119
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086
Mailing Address - Country:US
Mailing Address - Phone:702-791-9000
Mailing Address - Fax:702-224-6900
Practice Address - Street 1:6900 NORTH PECOS ROAD
Practice Address - Street 2:PHARMACY DEPARTMENT #119
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086
Practice Address - Country:US
Practice Address - Phone:702-791-9000
Practice Address - Fax:702-224-6900
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV065591835G0303X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist