Provider Demographics
NPI:1619367471
Name:TERRIER, DALE (CPHT)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:
Last Name:TERRIER
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 DISTRICT AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2273
Mailing Address - Country:US
Mailing Address - Phone:571-533-3752
Mailing Address - Fax:571-533-3762
Practice Address - Street 1:2905 DISTRICT AVE
Practice Address - Street 2:STE 400
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2273
Practice Address - Country:US
Practice Address - Phone:571-533-3752
Practice Address - Fax:571-533-3762
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230021280183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician