Provider Demographics
NPI:1295011187
Name:HUYCKE, KATHERINE THORNTON (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:THORNTON
Last Name:HUYCKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MAYMONT CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-6513
Mailing Address - Country:US
Mailing Address - Phone:703-402-9431
Mailing Address - Fax:
Practice Address - Street 1:4625 SHORE DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2745
Practice Address - Country:US
Practice Address - Phone:757-460-1674
Practice Address - Fax:757-460-2779
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist