Provider Demographics
NPI:1669770285
Name:POLL, KATHLEEN ALICE (RPH)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ALICE
Last Name:POLL
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 1:11406 POPLAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-2426
Mailing Address - Country:US
Mailing Address - Phone:804-794-2584
Mailing Address - Fax:
Practice Address - Street 1:4205 BEULAH RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23237-1449
Practice Address - Country:US
Practice Address - Phone:804-271-7207
Practice Address - Fax:804-743-0633
Is Sole Proprietor?:No
Enumeration Date:2011-03-06
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist