Provider Demographics
NPI:1205448230
Name:RUBIN, KATRINA HEIDI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:HEIDI
Last Name:RUBIN
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 1:1821 MACTAVISH AVE APT 2104
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4328
Mailing Address - Country:US
Mailing Address - Phone:703-887-9181
Mailing Address - Fax:
Practice Address - Street 1:3520 ELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2723
Practice Address - Country:US
Practice Address - Phone:804-342-8864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist