MEDICARE: KATHRYN CROSS PHARMD

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	0202210582	VA
2	183500000X	Pharmacist	16091	NC

General Provider Information

NPI Number	:	1174808497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN CROSS PHARMD

Provider Business Mailing Address
First Line	:	2400 GEORGE WASHINGTON MEM HWY
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-3404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 GEORGE WASHINGTON MEM HWY
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23693-3404
Country	:	US
Telephone Number	:	757-867-7109
Fax Number	:

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

Provider Enumeration Date	:	10/18/2011
Last Update Date	:	10/18/2011

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