Provider Demographics
NPI:1336913979
Name:LLOYD, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:LLOYD
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 1:713 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-3505
Mailing Address - Country:US
Mailing Address - Phone:434-579-2385
Mailing Address - Fax:
Practice Address - Street 1:621 BERRY HILL RD
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-2207
Practice Address - Country:US
Practice Address - Phone:434-572-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230024958183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No183700000XPharmacy Service ProvidersPharmacy Technician