Provider Demographics
NPI:1508148867
Name:TRELEASE, KATRINA C (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:C
Last Name:TRELEASE
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 1:90 ERNEST DR
Mailing Address - Street 2:
Mailing Address - City:WIRTZ
Mailing Address - State:VA
Mailing Address - Zip Code:24184-4393
Mailing Address - Country:US
Mailing Address - Phone:540-581-5053
Mailing Address - Fax:
Practice Address - Street 1:3590 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24078-1783
Practice Address - Country:US
Practice Address - Phone:276-647-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205200183500000X
NY045244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist