Active NPI
Cassandra Poullath
- Pharmacist
- Manassas, VA
National Provider Identifier
1538769732
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202207998
- Practice address
- 9401 Liberia Ave
Manassas, VA 20110-1718 - Phone
- (703) 257-0864
- Fax
- (703) 257-6356
- NPI assigned
- Oct 27, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202207998 | VA | Primary |
Addresses
Primary practice location
9401 Liberia Ave
Manassas, VA 20110-1718
Mailing address
8100 Landfall CT
Gainesville, VA 20155-3803
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202207998 | VA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603756800000",
"number": "1538769732",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8100 LANDFALL CT",
"city": "GAINESVILLE",
"state": "VA",
"postal_code": "201553803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9401 LIBERIA AVE",
"city": "MANASSAS",
"state": "VA",
"postal_code": "201101718",
"telephone_number": "703-257-0864",
"fax_number": "703-257-6356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POULLATH",
"first_name": "CASSANDRA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-27",
"last_updated": "2020-10-27",
"certification_date": "2020-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202207998",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manassas, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.