Provider Demographics
NPI:1851370183
Name:MASSEY, JESSICA LE (PHCY-TEC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:PHCY-TEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7683 SE 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2804
Mailing Address - Country:US
Mailing Address - Phone:425-454-3194
Mailing Address - Fax:
Practice Address - Street 1:7683 SE 27TH ST
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2804
Practice Address - Country:US
Practice Address - Phone:425-454-3194
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00051796183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician