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General NPI Number Information
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NPI Number | 1447892450
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Entity Type | Organization
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Legal Business Name | SEASIDE PHARMACY LLC
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Dates
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Enumeration Date | 10/10/2019
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 1630 DONNA DR STE 103
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-6188
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Country | US
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Telephone | 757-937-9548
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 DONNA DR STE 103
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-6188
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Country | US
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Telephone | 757-937-9548
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | CRAIG ROTH
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Credential | RPH
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Telephone | 757-937-9548
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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 |
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License Number State |
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