Provider Demographics
NPI:1720812613
Name:MASSEY, DEANNA JANAE' (RPH)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:JANAE'
Last Name:MASSEY
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 1:205 SUNSET PL APT 1
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:AR
Mailing Address - Zip Code:72132-8656
Mailing Address - Country:US
Mailing Address - Phone:870-250-9226
Mailing Address - Fax:
Practice Address - Street 1:5905 DOLLARWAY RD
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71602-3825
Practice Address - Country:US
Practice Address - Phone:870-534-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD17088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist