Provider Demographics
NPI:1790818854
Name:MASON, CELESTE M (RPH)
Entity type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:M
Last Name:MASON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20926 E GLEN HAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2465
Mailing Address - Country:US
Mailing Address - Phone:248-348-7408
Mailing Address - Fax:
Practice Address - Street 1:45001 FORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2907
Practice Address - Country:US
Practice Address - Phone:734-844-2733
Practice Address - Fax:734-844-2765
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist