Provider Demographics
NPI:1215133624
Name:DIETRICK, JUDY LIFLAND (RPH)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:LIFLAND
Last Name:DIETRICK
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 1:9611 PODIUM DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3338
Mailing Address - Country:US
Mailing Address - Phone:703-938-4384
Mailing Address - Fax:
Practice Address - Street 1:3833 N FAIRFAX DR
Practice Address - Street 2:SUITE 400
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203
Practice Address - Country:US
Practice Address - Phone:703-979-1425
Practice Address - Fax:703-979-1436
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist