Provider Demographics
NPI:1932158870
Name:VLASSIS, THEODORE (RPH)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:
Last Name:VLASSIS
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 1:3624 PEREGRINE CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1135
Mailing Address - Country:US
Mailing Address - Phone:717-682-1164
Mailing Address - Fax:
Practice Address - Street 1:261 LOCUST ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-1110
Practice Address - Country:US
Practice Address - Phone:717-684-2551
Practice Address - Fax:717-684-6239
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031994L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0864500001Medicare ID - Type Unspecified