Provider Demographics
NPI:1538437256
Name:MASSELINK, ALWIN (RPH)
Entity type:Individual
Prefix:
First Name:ALWIN
Middle Name:
Last Name:MASSELINK
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 1:2077 E AMBER LN
Mailing Address - Street 2:GILBERT
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2114
Mailing Address - Country:US
Mailing Address - Phone:480-633-0555
Mailing Address - Fax:
Practice Address - Street 1:1515 E WARNER RD
Practice Address - Street 2:GILBERT
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3138
Practice Address - Country:US
Practice Address - Phone:480-892-1348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS008347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS008347OtherAZ STATE BOARD OF PHARMACY LICENSE