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NPI Code Detail

MEDICARE: MR. MICHAEL JOHN KASSABIAN

MEDICARE: MR. MICHAEL JOHN KASSABIAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1730784331
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL JOHN KASSABIAN
Provider Business Mailing Address
First Line : 11 MAIN ST
Second Line :
City : WAKEFIELD
State : RI
Zip : 02879-3562
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11 MAIN ST
Second Line :
City : WAKEFIELD
State : RI
Zip : 02879-3569
Country : US
Telephone Number : 401-783-3384
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2020
Last Update Date : 12/01/2020

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Directions to “ MR. MICHAEL JOHN KASSABIAN ” Practice Location

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