Healthcare Provider Details

I. General information

NPI: 1114179579
Provider Name (Legal Business Name): MOHAN SRIKANTH CHITTA PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 RICHMOND RD STE B RITE AID PHARMACY
WILLIAMSBURG VA
23188-1995
US

IV. Provider business mailing address

540 CORAL CT APT 3D
NEWPORT NEWS VA
23606-4341
US

V. Phone/Fax

Practice location:
  • Phone: 757-565-6407
  • Fax: 757-565-6443
Mailing address:
  • Phone: 601-278-5549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202207683
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: