Provider Demographics
NPI:1528662871
Name:PATAKY, MEREDITH (PHARMD)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:PATAKY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11127 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-2528
Mailing Address - Country:US
Mailing Address - Phone:757-594-1374
Mailing Address - Fax:
Practice Address - Street 1:11127 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2528
Practice Address - Country:US
Practice Address - Phone:757-594-1374
Practice Address - Fax:757-594-1431
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202212982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist