MEDICARE: LAKSANA KIK RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202011989	VA

General Provider Information

NPI Number	:	1114245818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKSANA KIK RPH

Provider Business Mailing Address
First Line	:	6351 WILLOWFIELD WAY
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22150-1038
Country	:	US
Telephone Number	:	703-921-1989
Fax Number	:	703-751-2906

Provider Business Practice Location Address
First Line	:	4515 DUKE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-2503
Country	:	US
Telephone Number	:	703-751-4900
Fax Number	:	703-751-2906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	05/06/2010

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