Provider Demographics
NPI:1639835531
Name:MASSA, TYRA SHAE (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:TYRA
Middle Name:SHAE
Last Name:MASSA
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-4444
Mailing Address - Country:US
Mailing Address - Phone:559-901-1928
Mailing Address - Fax:559-624-0802
Practice Address - Street 1:262 N HIGHWAY 65
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:CA
Practice Address - Zip Code:93247-2702
Practice Address - Country:US
Practice Address - Phone:559-562-4404
Practice Address - Fax:559-562-1685
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH232110183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician