Provider Demographics
NPI:1629119698
Name:FRY, PAULA DUNCAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:DUNCAN
Last Name:FRY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 CHERRY VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-2171
Mailing Address - Country:US
Mailing Address - Phone:703-780-1575
Mailing Address - Fax:
Practice Address - Street 1:11480 COMMERCE PARK DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1554
Practice Address - Country:US
Practice Address - Phone:703-871-8586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005235183500000X
MD14851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist