Provider Demographics
NPI:1649590480
Name:MASON, ELIZABETH L (RPH, EMT)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:L
Last Name:MASON
Suffix:
Gender:F
Credentials:RPH, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 PARKER LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-1341
Mailing Address - Country:US
Mailing Address - Phone:610-604-0974
Mailing Address - Fax:
Practice Address - Street 1:510 E BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3836
Practice Address - Country:US
Practice Address - Phone:610-566-3218
Practice Address - Fax:610-566-0878
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA095889L146N00000X
PARP034772L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP034772LOtherPHARMACIST LICENSE NUMBER
PAPA095889LOtherEMERGENCY MEDICAL TECHNICIAN