Provider Demographics
NPI:1598361974
Name:GILLIGAN, KATHARINE MARY (RPH)
Entity Type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:MARY
Last Name:GILLIGAN
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 1:12420 DILLINGHAM SQ
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5258
Mailing Address - Country:US
Mailing Address - Phone:703-580-8211
Mailing Address - Fax:703-580-5111
Practice Address - Street 1:12420 DILLINGHAM SQ
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5258
Practice Address - Country:US
Practice Address - Phone:703-580-8211
Practice Address - Fax:703-580-5111
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist