Provider Demographics
NPI:1053628123
Name:MENISHER, MEKEDES
Entity Type:Individual
Prefix:
First Name:MEKEDES
Middle Name:
Last Name:MENISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7810 VANITY FAIR DR
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3327
Mailing Address - Country:US
Mailing Address - Phone:301-513-1759
Mailing Address - Fax:301-513-1759
Practice Address - Street 1:5600 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2927
Practice Address - Country:US
Practice Address - Phone:202-722-5252
Practice Address - Fax:202-722-4731
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH3126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist