Provider Demographics
NPI:1306169636
Name:MASSON, RUBY (RPH)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:
Last Name:MASSON
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 1:196 N BELLE MEAD RD STE 8
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3477
Mailing Address - Country:US
Mailing Address - Phone:631-804-6860
Mailing Address - Fax:631-689-2209
Practice Address - Street 1:196 N BELLE MEAD RD STE 8
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3477
Practice Address - Country:US
Practice Address - Phone:631-444-0784
Practice Address - Fax:631-689-2209
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037649-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist