Healthcare Provider Details

I. General information

NPI: 1285024927
Provider Name (Legal Business Name): MELINDA TERES HOLMES CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MOSAIC CT
STEPHENSON VA
22656-1892
US

IV. Provider business mailing address

215 MOSAIC CT
STEPHENSON VA
22656-1892
US

V. Phone/Fax

Practice location:
  • Phone: 703-407-7701
  • Fax:
Mailing address:
  • Phone: 703-407-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230022690
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: