Provider Demographics
NPI:1215062401
Name:MASSA, KAREN A (RPH)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:A
Last Name:MASSA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 POLO PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1360
Mailing Address - Country:US
Mailing Address - Phone:718-239-2892
Mailing Address - Fax:
Practice Address - Street 1:14919 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3849
Practice Address - Country:US
Practice Address - Phone:718-380-5440
Practice Address - Fax:718-380-3028
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY043838OtherNEW YORK STATE LICENSE