Provider Demographics
NPI:1558965756
Name:MASERATI, MICHAEL PETER (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PETER
Last Name:MASERATI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2439
Mailing Address - Country:US
Mailing Address - Phone:413-732-2998
Mailing Address - Fax:413-733-5452
Practice Address - Street 1:615 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2439
Practice Address - Country:US
Practice Address - Phone:413-732-2998
Practice Address - Fax:413-733-5452
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH27140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist