Provider Demographics
NPI:1174524631
Name:MASSA, BRUCE ALVIN (RPH)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ALVIN
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 1:1822 N CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-2565
Mailing Address - Country:US
Mailing Address - Phone:661-399-3337
Mailing Address - Fax:661-399-2926
Practice Address - Street 1:1822 N CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-2565
Practice Address - Country:US
Practice Address - Phone:661-399-3337
Practice Address - Fax:661-399-2926
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH27522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH27522OtherSTATE LICENSE