Provider Demographics
NPI:1083294557
Name:LASSIG, MICHAEL ANNE
Entity Type:Individual
Prefix:MRS
First Name:MICHAEL
Middle Name:ANNE
Last Name:LASSIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 IH 35 S
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-1013
Mailing Address - Country:US
Mailing Address - Phone:254-799-0219
Mailing Address - Fax:
Practice Address - Street 1:801 IH 35 S
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-1013
Practice Address - Country:US
Practice Address - Phone:254-799-0219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193042183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician