Healthcare Provider Details

I. General information

NPI: 1932158870
Provider Name (Legal Business Name): THEODORE VLASSIS R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 LOCUST ST
COLUMBIA PA
17512-1110
US

IV. Provider business mailing address

3624 PEREGRINE CIR
MOUNTVILLE PA
17554-1135
US

V. Phone/Fax

Practice location:
  • Phone: 717-684-2551
  • Fax: 717-684-6239
Mailing address:
  • Phone: 717-682-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP031994L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: