Healthcare Provider Details

I. General information

NPI: 1992541718
Provider Name (Legal Business Name): MARIA TSIKERDANOS PHARMD, MBA, CSM
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COLLEGE DR STE 200
MIDDLEBURG FL
32068-8525
US

IV. Provider business mailing address

400 COLLEGE DR STE 200
MIDDLEBURG FL
32068-8525
US

V. Phone/Fax

Practice location:
  • Phone: 904-213-2700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number033.0135410
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: