Healthcare Provider Details

I. General information

NPI: 1487644795
Provider Name (Legal Business Name): SENTARA LIFE CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 INDEPENDENCE BLVD SUITE 100
VIRGINIA BEACH VA
23455-6005
US

IV. Provider business mailing address

800 INDEPENDENCE BLVD SUITE 100
VIRGINIA BEACH VA
23455-6005
US

V. Phone/Fax

Practice location:
  • Phone: 757-252-0975
  • Fax: 757-363-6104
Mailing address:
  • Phone: 757-252-0975
  • Fax: 757-363-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number07702
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number0201003712
License Number StateVA

VIII. Authorized Official

Name: DR. MARIA ACHILLEOS
Title or Position: CLINICAL PHARMACY SPECIALIST
Credential: PHARMD
Phone: 757-252-0988