Provider Demographics
NPI:1588305098
Name:PARK, MASON ALEXANDER (PHARMD)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:ALEXANDER
Last Name:PARK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 HOPEWELL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7103
Mailing Address - Country:US
Mailing Address - Phone:842-972-6191
Mailing Address - Fax:
Practice Address - Street 1:730 HOPEWELL DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492-7103
Practice Address - Country:US
Practice Address - Phone:843-972-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist