Provider Demographics
NPI:1396356945
Name:KASSA, MICHAEL K (PHARMDD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:KASSA
Suffix:
Gender:M
Credentials:PHARMDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3717
Mailing Address - Country:US
Mailing Address - Phone:202-789-5345
Mailing Address - Fax:202-789-4192
Practice Address - Street 1:801 7TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3717
Practice Address - Country:US
Practice Address - Phone:202-789-5345
Practice Address - Fax:202-789-4192
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100002220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist