Provider Demographics
NPI:1114245818
Name:KIK, LAKSANA (RPH)
Entity Type:Individual
Prefix:
First Name:LAKSANA
Middle Name:
Last Name:KIK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6351 WILLOWFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1038
Mailing Address - Country:US
Mailing Address - Phone:703-921-1989
Mailing Address - Fax:703-751-2906
Practice Address - Street 1:4515 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2503
Practice Address - Country:US
Practice Address - Phone:703-751-4900
Practice Address - Fax:703-751-2906
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist