Provider Demographics
NPI:1700282530
Name:BECKER, KATRISHA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KATRISHA
Middle Name:
Last Name:BECKER
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 1:740 GEYSER RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2906
Mailing Address - Country:US
Mailing Address - Phone:518-332-7344
Mailing Address - Fax:518-875-9417
Practice Address - Street 1:11140 WESTERN TPKE
Practice Address - Street 2:
Practice Address - City:ESPERANCE
Practice Address - State:NY
Practice Address - Zip Code:12066-3010
Practice Address - Country:US
Practice Address - Phone:518-875-9414
Practice Address - Fax:518-875-9417
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI0582931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist