Provider Demographics
NPI:1225637499
Name:MASSEY, WALTER MONROE III (RPH)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:MONROE
Last Name:MASSEY
Suffix:III
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 1:2463 WOOD TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4846
Mailing Address - Country:US
Mailing Address - Phone:404-314-9077
Mailing Address - Fax:
Practice Address - Street 1:1227 ROCKBRIDGE RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3064
Practice Address - Country:US
Practice Address - Phone:770-225-1888
Practice Address - Fax:770-225-1889
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0144851835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist