Provider Demographics
NPI:1902006067
Name:MAASS, MICHAEL T (RPH PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:MAASS
Suffix:
Gender:M
Credentials:RPH PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950
Mailing Address - Country:US
Mailing Address - Phone:631-374-5713
Mailing Address - Fax:
Practice Address - Street 1:790 PARK PLACE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561
Practice Address - Country:US
Practice Address - Phone:516-536-0800
Practice Address - Fax:516-889-4500
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0374481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist