Provider Demographics
NPI:1639461213
Name:DREY, ANETA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANETA
Middle Name:
Last Name:DREY
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 1:3905 FAIR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2906
Mailing Address - Country:US
Mailing Address - Phone:703-877-0584
Mailing Address - Fax:703-877-0592
Practice Address - Street 1:3905 FAIR RIDGE DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2906
Practice Address - Country:US
Practice Address - Phone:703-877-0584
Practice Address - Fax:703-877-0592
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist