Provider Demographics
NPI:1366554065
Name:CHACKO, CLAYTON C (RPH)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:C
Last Name:CHACKO
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 1:801 4TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-2239
Mailing Address - Country:US
Mailing Address - Phone:724-483-0217
Mailing Address - Fax:724-565-1051
Practice Address - Street 1:801 4TH ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-2239
Practice Address - Country:US
Practice Address - Phone:724-483-0217
Practice Address - Fax:724-565-1051
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-031427-L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist