Provider Demographics
NPI:1932576840
Name:MASSIS, FARIS (RPH)
Entity Type:Individual
Prefix:
First Name:FARIS
Middle Name:
Last Name:MASSIS
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 1:368 WISETON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-3545
Mailing Address - Country:US
Mailing Address - Phone:702-263-4270
Mailing Address - Fax:702-263-4305
Practice Address - Street 1:490 E SILVERADO RANCH BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-6290
Practice Address - Country:US
Practice Address - Phone:702-263-4270
Practice Address - Fax:702-263-4305
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist