Provider Demographics
NPI:1053926782
Name:MASSO, NICHOLAS (RPH)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:MASSO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 MILL AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5922
Mailing Address - Country:US
Mailing Address - Phone:718-531-0408
Mailing Address - Fax:
Practice Address - Street 1:2064 MILL AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5922
Practice Address - Country:US
Practice Address - Phone:718-531-0408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist