Provider Demographics
NPI:1972895563
Name:DICE, TERESA (PHARM D)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:DICE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42780 CREEK VIEW PLZ STE 150
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4054
Mailing Address - Country:US
Mailing Address - Phone:571-223-2335
Mailing Address - Fax:571-223-3836
Practice Address - Street 1:42780 CREEK VIEW PLZ STE 150
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4054
Practice Address - Country:US
Practice Address - Phone:571-223-2335
Practice Address - Fax:571-223-3836
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist