Provider Demographics
NPI:1457550618
Name:DEAN, ASHLEY HEATHER
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:HEATHER
Last Name:DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11530 OLDE TIVERTON CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1942
Mailing Address - Country:US
Mailing Address - Phone:716-397-4532
Mailing Address - Fax:
Practice Address - Street 1:46965 CEDAR LAKE PLZ
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-8653
Practice Address - Country:US
Practice Address - Phone:703-430-3328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist