Healthcare Provider Details

I. General information

NPI: 1760640320
Provider Name (Legal Business Name): KRISTINA MICHELE SYKES PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BUTLER AVE
MARTINSBURG WV
25405-9990
US

IV. Provider business mailing address

384 GOOD DR
MARTINSBURG WV
25405-9585
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-1000
  • Fax:
Mailing address:
  • Phone: 703-655-0137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0007048
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: