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General NPI Number Information
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NPI Number | 1851999320
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Entity Type | Individual
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Provider Name | DONALD BRADLEY MASSOPUST
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Gender | Male
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 2500 LAKE SHORE DR E
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City | ASHLAND
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State | WI
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Zip | 54806-2421
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Country | US
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Telephone | 715-682-3660
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Fax | 715-685-9941
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Provider Business Mailing Address
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Address Line | 229 E ARCH ST
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City | IRONWOOD
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State | MI
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Zip | 49938-2003
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Country | US
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Telephone | 906-364-2771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10793
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License Number State | WI
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