Provider Demographics
NPI:1194370411
Name:MASON, VIRGINIA ELLIS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:ELLIS
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 1:35 FOLLY ROAD BLVD UNIT 232
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-8302
Mailing Address - Country:US
Mailing Address - Phone:843-372-8840
Mailing Address - Fax:
Practice Address - Street 1:380 KING ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1411
Practice Address - Country:US
Practice Address - Phone:843-714-6243
Practice Address - Fax:843-714-6538
Is Sole Proprietor?:No
Enumeration Date:2019-08-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist