Provider Demographics
NPI:1700186442
Name:RICH, SHIRLEY GREGG (RPH)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:GREGG
Last Name:RICH
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 1:10614 JOHN AYRES DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3115
Mailing Address - Country:US
Mailing Address - Phone:703-250-2733
Mailing Address - Fax:
Practice Address - Street 1:5727 BURKE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2204
Practice Address - Country:US
Practice Address - Phone:703-323-8786
Practice Address - Fax:703-239-9266
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist