Provider Demographics
NPI:1811289614
Name:SKLAVOS, PETER
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:SKLAVOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N ANTRIM WAY
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:17225-1406
Mailing Address - Country:US
Mailing Address - Phone:717-597-4617
Mailing Address - Fax:717-597-7882
Practice Address - Street 1:200 N ANTRIM WAY
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:PA
Practice Address - Zip Code:17225-1406
Practice Address - Country:US
Practice Address - Phone:717-597-4617
Practice Address - Fax:717-597-7882
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043391L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist