Provider Demographics
NPI:1801179676
Name:MASOTTI, WILLIAM HARRY (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HARRY
Last Name:MASOTTI
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 1:130 PRISON ST
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1247
Mailing Address - Country:US
Mailing Address - Phone:808-661-4747
Mailing Address - Fax:808-661-1918
Practice Address - Street 1:130 PRISON ST
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1247
Practice Address - Country:US
Practice Address - Phone:808-661-4747
Practice Address - Fax:808-661-1918
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist