Provider Demographics
NPI:1023158581
Name:MASSA, JOHN EDWARD (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:MASSA
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 1:32 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-9282
Mailing Address - Country:US
Mailing Address - Phone:219-464-4546
Mailing Address - Fax:
Practice Address - Street 1:2022 KELLE DR
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-8708
Practice Address - Country:US
Practice Address - Phone:219-395-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26011997A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy