Provider Demographics
NPI:1174206205
Name:HERRICK, MASON PAIGE (PHARMD)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:PAIGE
Last Name:HERRICK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MASON
Other - Middle Name:PAIGE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1140 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2017
Mailing Address - Country:US
Mailing Address - Phone:641-684-5467
Mailing Address - Fax:641-683-8364
Practice Address - Street 1:1140 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2017
Practice Address - Country:US
Practice Address - Phone:641-684-5467
Practice Address - Fax:641-683-8364
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty