Provider Demographics
NPI:1891398962
Name:POWERS, KRISTINE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:POWERS
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 1:6100 LAKESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-5237
Mailing Address - Country:US
Mailing Address - Phone:804-266-7686
Mailing Address - Fax:
Practice Address - Street 1:6100 LAKESIDE AVE
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-5237
Practice Address - Country:US
Practice Address - Phone:804-266-7686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202215848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist