Provider Demographics
NPI:1811270614
Name:MASON, LATANYA YVONNE (PHARMD)
Entity type:Individual
Prefix:
First Name:LATANYA
Middle Name:YVONNE
Last Name:MASON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 W 47TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-3245
Mailing Address - Country:US
Mailing Address - Phone:773-247-3051
Mailing Address - Fax:773-247-5047
Practice Address - Street 1:1614 W 47TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-3245
Practice Address - Country:US
Practice Address - Phone:773-247-3051
Practice Address - Fax:773-247-5047
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.037947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist