Provider Demographics
NPI:1134440753
Name:POULSON, CASSANDRA ANNETTE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:ANNETTE
Last Name:POULSON
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 1:322 BLACKSMITH ARCH
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-4510
Mailing Address - Country:US
Mailing Address - Phone:757-224-9262
Mailing Address - Fax:
Practice Address - Street 1:40 TOWNE CENTER WAY
Practice Address - Street 2:RITE-AID PHARMACY 11290
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-825-0102
Practice Address - Fax:757-826-1675
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist