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General NPI Number Information
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NPI Number | 1487644795
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Entity Type | Organization
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Legal Business Name | SENTARA LIFE CARE CORPORATION
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 03/30/2018
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Provider Practice Location Address
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Address Line | 800 INDEPENDENCE BLVD SUITE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-6005
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Country | US
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Telephone | 757-252-0975
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Fax | 757-363-6104
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Provider Business Mailing Address
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Address Line | 800 INDEPENDENCE BLVD SUITE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-6005
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Country | US
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Telephone | 757-252-0975
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Fax | 757-363-6104
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Authorized Official
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Title or Position | CLINICAL PHARMACY SPECIALIST
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Name | DR. MARIA ACHILLEOS
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Credential | PHARMD
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Telephone | 757-252-0988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 07702
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 0201003712
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License Number State | VA
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