Provider Demographics
NPI:1649677550
Name:AKILI, GINO (PHARMD)
Entity type:Individual
Prefix:
First Name:GINO
Middle Name:
Last Name:AKILI
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:GINO
Other - Middle Name:
Other - Last Name:AKILI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:100 EMANCIPATION DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23667-0001
Mailing Address - Country:US
Mailing Address - Phone:757-768-0957
Mailing Address - Fax:
Practice Address - Street 1:6135 E VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-2701
Practice Address - Country:US
Practice Address - Phone:757-466-7962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist