Provider Demographics
NPI:1275853822
Name:MASSOUD, MAURICE A (RPH)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:A
Last Name:MASSOUD
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 1:1201 S COAST HWY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-5119
Mailing Address - Country:US
Mailing Address - Phone:760-433-4013
Mailing Address - Fax:760-433-4316
Practice Address - Street 1:1201 S COAST HWY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-5119
Practice Address - Country:US
Practice Address - Phone:760-433-4013
Practice Address - Fax:760-433-4316
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist