Provider Demographics
NPI:1417746173
Name:LABASH, MASON (PHARMD)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:LABASH
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21792 HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-9670
Mailing Address - Country:US
Mailing Address - Phone:650-346-8797
Mailing Address - Fax:
Practice Address - Street 1:1720 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-3602
Practice Address - Country:US
Practice Address - Phone:707-839-5621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist