Katrina Briceland Van Der Kloet, PHARM. D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

20057619 Issued in NY

Practice address

5206 W Genesee St
Camillus, NY 13031-2202

Phone

(315) 468-1701

NPI assigned

Dec 20, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walgreen Co

  • Pharmacy
  • Camillus, NY
  • NPI 1831124841
  NPD (past)
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405382400000",
    "number": "1134498181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5206 W GENESEE ST",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130312202",
            "telephone_number": "315-468-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5206 W GENESEE ST",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130312202",
            "telephone_number": "315-468-1701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DER KLOET",
        "first_name": "KATRINA",
        "middle_name": "BRICELAND",
        "name_prefix": "Dr.",
        "credential": "PHARM. D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-20",
        "last_updated": "2014-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "43935",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "20057619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Albert T Tripodi, MD
• Lisa Beth Trivison, CCC-SLP
• Sheng-Han Tsai
• Upstate Orthopedics, LLP
• Susan E Valerino, PT
• Mari-Lee L Van Scoter
• Michelle Vanhatten, LMFT
• Stacia L Vanslyke, MD
• Toni Jean Vella, LPN
• Vince'S Pharmacy of Camillus Inc

• All providers in Camillus, NY
• Pharmacist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.