Provider Demographics
NPI:1649986738
Name:WASSOM, JOACHIM (RPH)
Entity type:Individual
Prefix:DR
First Name:JOACHIM
Middle Name:
Last Name:WASSOM
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 1:9552 W TROPICANA AVE APT 2051
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8477
Mailing Address - Country:US
Mailing Address - Phone:702-350-5815
Mailing Address - Fax:
Practice Address - Street 1:9552 W TROPICANA AVE APT 2051
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8477
Practice Address - Country:US
Practice Address - Phone:702-350-5815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23326183500000X
AZS026306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist