Provider Demographics
NPI:1831799188
Name:IVES, MEREDITH LEIGH
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:LEIGH
Last Name:IVES
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 1:5501 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-3795
Mailing Address - Country:US
Mailing Address - Phone:757-274-7339
Mailing Address - Fax:
Practice Address - Street 1:4625 SHORE DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-2745
Practice Address - Country:US
Practice Address - Phone:757-460-1674
Practice Address - Fax:757-460-2779
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022151831835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist