Provider Demographics
NPI:1831781103
Name:SOUDERS, KRISTEN NOELLE (RPH)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:NOELLE
Last Name:SOUDERS
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 1:3536 VALEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2244
Mailing Address - Country:US
Mailing Address - Phone:703-851-2382
Mailing Address - Fax:703-592-6934
Practice Address - Street 1:8505 ARLINGTON BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4636
Practice Address - Country:US
Practice Address - Phone:703-495-3350
Practice Address - Fax:703-592-6934
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist