Provider Demographics
NPI:1740575364
Name:WASALASKI, KATIE STEPHENS
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:STEPHENS
Last Name:WASALASKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5902 MOUNT EAGLE DR APT 310
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-2515
Mailing Address - Country:US
Mailing Address - Phone:703-855-3551
Mailing Address - Fax:
Practice Address - Street 1:5115 LEESBURG PIKE
Practice Address - Street 2:1893
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3207
Practice Address - Country:US
Practice Address - Phone:703-253-0022
Practice Address - Fax:703-253-0022
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist