MEDICARE: DR. MENGISTU FEKEDE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202205686	VA

General Provider Information

NPI Number	:	1205156882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MENGISTU FEKEDE PHARMD

Provider Business Mailing Address
First Line	:	3453 LOGSTONE DR
Second Line	:
City	:	TRIANGLE
State	:	VA
Zip	:	22172-2056
Country	:	US
Telephone Number	:	703-772-5745
Fax Number	:

Provider Business Practice Location Address
First Line	:	1521-1523 NORTH QUAKER LANE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302
Country	:	US
Telephone Number	:	703-998-6560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	11/09/2021

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