Active NPI
Katrina Briceland Van Der Kloet, PHARM. D.
- Pharmacist
- Camillus, NY
National Provider Identifier
1134498181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 20057619
- Practice address
- 5206 W Genesee St
Camillus, NY 13031-2202 - Phone
- (315) 468-1701
- NPI assigned
- Dec 20, 2011
- Last updated
- Jul 15, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 43935 | FL | |
| Pharmacist | 183500000X | 20057619 | NY | Primary |
Addresses
Primary practice location
5206 W Genesee St
Camillus, NY 13031-2202
Mailing address
5206 W Genesee St
Camillus, NY 13031-2202
Phone (315) 468-1701
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43935 | FL | MD | Pharmacist |
| 20057619 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
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": []
}Other providers in Camillus, NY
Sources for this page
- 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.