Provider Demographics
NPI:1093052888
Name:MASSENGALE, DEENA SUZANNE (PHARMD, RPH)
Entity Type:Individual
Prefix:MRS
First Name:DEENA
Middle Name:SUZANNE
Last Name:MASSENGALE
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 DACULA RD
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7055
Mailing Address - Country:US
Mailing Address - Phone:770-822-6229
Mailing Address - Fax:770-822-6028
Practice Address - Street 1:720 DACULA RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7055
Practice Address - Country:US
Practice Address - Phone:770-822-6229
Practice Address - Fax:770-822-6028
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019942183500000X
FLPS35891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist