Provider Demographics
NPI:1487644795
Name:SENTARA LIFE CARE CORPORATION
Entity Type:Organization
Organization Name:SENTARA LIFE CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PHARMACY SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHILLEOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:757-252-0988
Mailing Address - Street 1:800 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6005
Mailing Address - Country:US
Mailing Address - Phone:757-252-0975
Mailing Address - Fax:757-363-6104
Practice Address - Street 1:800 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6005
Practice Address - Country:US
Practice Address - Phone:757-252-0975
Practice Address - Fax:757-363-6104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010037123336L0003X
NC077023336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4835813OtherNABP
VA008519251Medicaid
19199OtherOPTIMA PROVIDER #
NC0497061Medicaid
245139OtherANTHEM PROVIDER #
4437379OtherAETNA PROVIDER#