Provider Demographics
NPI:1972083236
Name:MASSEY, KAREN LYNN
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LYNN
Last Name:MASSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12805 S GRANDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-7608
Mailing Address - Country:US
Mailing Address - Phone:509-628-9554
Mailing Address - Fax:
Practice Address - Street 1:515 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3737
Practice Address - Country:US
Practice Address - Phone:509-547-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00019074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
907074OtherNABP