Provider Demographics
NPI:1396036257
Name:SCHLEY, MIGNON TALA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIGNON
Middle Name:TALA
Last Name:SCHLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MIGNON
Other - Middle Name:TALA
Other - Last Name:SCHLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6600 SPRINGFIELD MALL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150
Mailing Address - Country:US
Mailing Address - Phone:703-921-9003
Mailing Address - Fax:703-921-9003
Practice Address - Street 1:6600 SPRINGFIELD MALL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1712
Practice Address - Country:US
Practice Address - Phone:703-921-9003
Practice Address - Fax:703-921-9003
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207671183500000X
MD20080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist