MEDICARE: LAURA KINGKADE 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	0202210111	VA

General Provider Information

NPI Number	:	1235424631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA KINGKADE PHARMD

Provider Business Mailing Address
First Line	:	7101 FOREST HILL AVE
Second Line	:	T-1931
City	:	RICHMOND
State	:	VA
Zip	:	23225-1553
Country	:	US
Telephone Number	:	804-330-3526
Fax Number	:

Provider Business Practice Location Address
First Line	:	7101 FOREST HILL AVE
Second Line	:	T-1931
City	:	RICHMOND
State	:	VA
Zip	:	23225-1553
Country	:	US
Telephone Number	:	804-330-3526
Fax Number	:

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

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	06/14/2011

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