Provider Demographics
NPI:1770873911
Name:NUMA, ANDREW MASATO (BSCPHARM)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MASATO
Last Name:NUMA
Suffix:
Gender:M
Credentials:BSCPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S RUBY ST
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3713
Mailing Address - Country:US
Mailing Address - Phone:509-859-4014
Mailing Address - Fax:509-925-6069
Practice Address - Street 1:700 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3641
Practice Address - Country:US
Practice Address - Phone:509-925-4232
Practice Address - Fax:509-925-6069
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60203235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist