Provider Demographics
NPI:1083175046
Name:VLASSES, PETER HARRIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:HARRIS
Last Name:VLASSES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5246
Mailing Address - Country:US
Mailing Address - Phone:312-560-3146
Mailing Address - Fax:630-469-2290
Practice Address - Street 1:356 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5246
Practice Address - Country:US
Practice Address - Phone:312-560-3146
Practice Address - Fax:630-469-2290
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-30
Last Update Date:2019-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0512870941835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist