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General NPI Number Information
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NPI Number | 1275630105
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Entity Type | Organization
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Legal Business Name | SRI DRUG CENTER PHARMACY LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 02/03/2023
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Provider Practice Location Address
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Address Line | 912 AIRLINE BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23707-3309
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Country | US
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Telephone | 757-399-6361
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Fax | 757-399-1897
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Provider Business Mailing Address
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Address Line | 912 AIRLINE BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23707-3309
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Country | US
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Telephone | 757-399-6361
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Fax | 757-399-1897
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Authorized Official
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Title or Position | OFFICER
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Name | SRIDHAR GOTTIPATI
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Credential | B.S IN PHARMACY
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Telephone | 919-986-2547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 0201001994
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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