Provider Demographics
NPI:1588820492
Name:MASSO, SAMMY ROBERT (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMMY
Middle Name:ROBERT
Last Name:MASSO
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 1:622 EDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:OVILLA
Mailing Address - State:TX
Mailing Address - Zip Code:75154-1662
Mailing Address - Country:US
Mailing Address - Phone:972-217-1935
Mailing Address - Fax:
Practice Address - Street 1:2962 S LONGHORN DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-2118
Practice Address - Country:US
Practice Address - Phone:972-228-6246
Practice Address - Fax:972-228-5646
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist