Provider Demographics
NPI:1205156882
Name:FEKEDE, MENGISTU (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MENGISTU
Middle Name:
Last Name:FEKEDE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3453 LOGSTONE DR
Mailing Address - Street 2:
Mailing Address - City:TRIANGLE
Mailing Address - State:VA
Mailing Address - Zip Code:22172-2056
Mailing Address - Country:US
Mailing Address - Phone:703-772-5745
Mailing Address - Fax:
Practice Address - Street 1:1521-1523 NORTH QUAKER LANE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302
Practice Address - Country:US
Practice Address - Phone:703-998-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist