Provider Demographics
NPI:1154029262
Name:CLASSO, PETER-CLAVER (RPH)
Entity type:Individual
Prefix:MR
First Name:PETER-CLAVER
Middle Name:
Last Name:CLASSO
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 1:5808 COLDSWORTH CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-2386
Mailing Address - Country:US
Mailing Address - Phone:817-851-8448
Mailing Address - Fax:
Practice Address - Street 1:6151 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-2206
Practice Address - Country:US
Practice Address - Phone:817-465-6537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX032131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist