Provider Demographics
NPI:1942849443
Name:KLASKY, JUSTIN GEORGE
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:GEORGE
Last Name:KLASKY
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 1:9113 E RAINSAGE ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5387
Mailing Address - Country:US
Mailing Address - Phone:520-271-0018
Mailing Address - Fax:
Practice Address - Street 1:9113 E RAINSAGE ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-5387
Practice Address - Country:US
Practice Address - Phone:520-271-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZT027744183700000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No183700000XPharmacy Service ProvidersPharmacy Technician