Provider Demographics
NPI:1356944177
Name:GLOTFELTY, MEKEDA ANTOINETTE I
Entity type:Individual
Prefix:
First Name:MEKEDA
Middle Name:ANTOINETTE
Last Name:GLOTFELTY
Suffix:I
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 1:4532 TURNWORTH ARCH
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-7786
Mailing Address - Country:US
Mailing Address - Phone:757-256-3911
Mailing Address - Fax:
Practice Address - Street 1:4821 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6710
Practice Address - Country:US
Practice Address - Phone:757-278-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist