Healthcare Provider Details

I. General information

NPI: 1477156933
Provider Name (Legal Business Name): KATRINA KLAG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8124 ARLINGTON BLVD
FALLS CHURCH VA
22042-1002
US

IV. Provider business mailing address

6592 BERMUDA GREEN CT
ALEXANDRIA VA
22312-3104
US

V. Phone/Fax

Practice location:
  • Phone: 703-560-7280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202212194
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: