Provider Demographics
NPI:1548635337
Name:MASSO, KAREN NELSON (RPH)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:NELSON
Last Name:MASSO
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 1:5450 E DEER VALLEY DR UNIT 3220
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-8114
Mailing Address - Country:US
Mailing Address - Phone:860-559-1053
Mailing Address - Fax:
Practice Address - Street 1:5450 E DEER VALLEY DR UNIT 3220
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-8114
Practice Address - Country:US
Practice Address - Phone:860-559-1053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-05
Last Update Date:2015-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist