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NPI Code Detail

MEDICARE: MR. THEODORE VLASSIS R.PH

MEDICARE: MR. THEODORE VLASSIS R.PH
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
1183500000XPharmacistRP031994LPA

General Provider Information

NPI Number : 1932158870
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THEODORE VLASSIS R.PH
Provider Business Mailing Address
First Line : 3624 PEREGRINE CIR
Second Line :
City : MOUNTVILLE
State : PA
Zip : 17554-1135
Country : US
Telephone Number : 717-682-1164
Fax Number :
Provider Business Practice Location Address
First Line : 261 LOCUST ST
Second Line :
City : COLUMBIA
State : PA
Zip : 17512-1110
Country : US
Telephone Number : 717-684-2551
Fax Number : 717-684-6239
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2006
Last Update Date : 10/15/2020

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