Healthcare Provider Details

I. General information

NPI: 1730443995
Provider Name (Legal Business Name): DR. GLWADYS MEJIEU LEKANE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 RICHMOND HWY
ALEXANDRIA VA
22306-6410
US

IV. Provider business mailing address

6303 RICHMOND HWY
ALEXANDRIA VA
22306-6410
US

V. Phone/Fax

Practice location:
  • Phone: 703-253-9908
  • Fax: 703-253-9902
Mailing address:
  • Phone: 703-253-9908
  • Fax: 703-253-9902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number23816
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0202214442
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: