Provider Demographics
NPI:1407828965
Name:CLASEN, THOMAS E (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:E
Last Name:CLASEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GARDENVILLE DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-4407
Mailing Address - Country:US
Mailing Address - Phone:757-867-9040
Mailing Address - Fax:
Practice Address - Street 1:1721 TAUSSIG BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511
Practice Address - Country:US
Practice Address - Phone:757-314-6397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-02-13
Deactivation Date:2017-12-05
Deactivation Code:
Reactivation Date:2018-02-13
Provider Licenses
StateLicense IDTaxonomies
VA0202006801183500000X
WI8279-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist