Basic Information
Provider Information
NPI: 1780261032
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARIDA
FirstName: MEAGAN
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1213 GUNSMITH CT APT 204
Address2:  
City: VIRGINIA BEACH
State: VA
PostalCode: 234644811
CountryCode: US
TelephoneNumber: 7579183615
FaxNumber:  
Practice Location
Address1: 1832 KEMPSVILLE RD
Address2:  
City: VIRGINIA BEACH
State: VA
PostalCode: 234646861
CountryCode: US
TelephoneNumber: 7572782573
FaxNumber: 7572782567
Other Information
ProviderEnumerationDate: 03/24/2021
LastUpdateDate: 03/24/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/24/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183700000X0230025360VAY Pharmacy Service ProvidersPharmacy Technician 

No ID Information.


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