MEDICARE: DR. SHAKOLA KINGSTON PHARM, D

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	0202215423	VA

General Provider Information

NPI Number	:	1578005583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAKOLA KINGSTON PHARM, D

Provider Business Mailing Address
First Line	:	12501 STONE VILLAGE WAY
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-2715
Country	:	US
Telephone Number	:	804-419-9945
Fax Number	:

Provider Business Practice Location Address
First Line	:	12501 STONE VILLAGE WAY
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-2715
Country	:	US
Telephone Number	:	804-419-9945
Fax Number	:

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

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	03/01/2024

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